1255330593 NPI number — LOUIS V. ANGIOLETTI JR. M. D., P. A.

Table of content: (NPI 1255330593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255330593 NPI number — LOUIS V. ANGIOLETTI JR. M. D., P. A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUIS V. ANGIOLETTI JR. M. D., P. A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1255330593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1617 PALISADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-6930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-214-8140
Provider Business Mailing Address Fax Number:
201-947-1902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1617 PALISADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-6930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-214-8140
Provider Business Practice Location Address Fax Number:
201-947-1902
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANGIOLETTI
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-214-8140

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , 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: 01370034 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2818809 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com