Provider Demographics
NPI:1083863948
Name:DRAGOTTO, ANGELA
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:DRAGOTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 FREDERICK CT
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1058
Mailing Address - Country:US
Mailing Address - Phone:201-403-1645
Mailing Address - Fax:201-447-8922
Practice Address - Street 1:44 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1969
Practice Address - Country:US
Practice Address - Phone:201-389-3276
Practice Address - Fax:201-447-8922
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00163200156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician