Provider Demographics
NPI:1083601934
Name:ANGELLO, PHILIP JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:ANGELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 ROUTE 34 STE 813
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2440
Mailing Address - Country:US
Mailing Address - Phone:732-431-2620
Mailing Address - Fax:732-431-3707
Practice Address - Street 1:281 ROUTE 34 STE 813
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2440
Practice Address - Country:US
Practice Address - Phone:732-431-2620
Practice Address - Fax:732-431-3707
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8101302Medicaid
NJ8101302Medicaid