Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 219231 | NY |
NPI | 1003886854 |
---|---|
Provider Name | Dr. John D'angelo |
First Address | Westbury, NY 11590-1740 |
Second Address | Glen Cove, NY 11542-2254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02163606 | (05) | NY |
G61936 | (02) | NY |