1811991458 NPI number — MS. SHARON ANGELO D.O.

Table of content: MS. SHARON ANGELO D.O. (NPI 1811991458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811991458 NPI number — MS. SHARON ANGELO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGELO
Provider First Name:
SHARON
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1811991458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 AVENUE AT THE CMN
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07702-4569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-380-9000
Provider Business Mailing Address Fax Number:
732-380-9232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 AVENUE AT THE CMN
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07702-4569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-380-9000
Provider Business Practice Location Address Fax Number:
732-380-9232
Provider Enumeration Date:
06/10/2005

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: 207R00000X , with the licence number:  MB56774 , 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: P3590285 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J34726 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0492485002 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 110095494 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0492473 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 754781 . This is a "WELLCHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223326706 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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