Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 033658-1 | NY |
NPI | 1073729968 |
---|---|
Provider Name | Dr. Dennis George Angelillo |
First Address | Nyack, NY 10960-2017 |
Second Address | Nyack, NY 10960-2017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0536065 | (02) | NY |