1245215664 NPI number — DR. SALVATORE DANGELO M D

Table of content: DR. SALVATORE DANGELO M D (NPI 1245215664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245215664 NPI number — DR. SALVATORE DANGELO M D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANGELO
Provider First Name:
SALVATORE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245215664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 S MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07450-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-445-4557
Provider Business Mailing Address Fax Number:
201-445-2365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 S MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-4509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-445-4557
Provider Business Practice Location Address Fax Number:
201-445-2365
Provider Enumeration Date:
12/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA29612 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0201X , with the licence number: 25MA02961200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0493902 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1111081 . This is a "HORIZON N.J. FAMILYCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1161071 . This is a "HORIZON N.J. FAMILYCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01078270 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0150142000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3284699 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8328385 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8828709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".