1528067832 NPI number — LOUIS V ANGIOLETTI JR. M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528067832 NPI number — LOUIS V ANGIOLETTI JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGIOLETTI
Provider First Name:
LOUIS
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
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:
1528067832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CORPORATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-987-3380
Provider Business Mailing Address Fax Number:
866-806-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1086 TEANECK ROAD
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-871-3414
Provider Business Practice Location Address Fax Number:
201-871-4830
Provider Enumeration Date:
07/19/2005

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: 207W00000X , with the licence number:  105144-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: 25MA10886200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 25MA02310800 , 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: 518496 . This is a "AETNA INSURANCE CO." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NS416 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 00305091 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: OC5520 . This is a "HEALTHNET INSURANCE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 525135 . This is a "AETNA INSURANCE COMPANY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1369407 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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