Provider Demographics
NPI:1093992356
Name:DR NICHOLAS A D'ANGELO
Entity Type:Organization
Organization Name:DR NICHOLAS A D'ANGELO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-837-7300
Mailing Address - Street 1:6511 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3912
Mailing Address - Country:US
Mailing Address - Phone:718-837-7300
Mailing Address - Fax:718-837-6674
Practice Address - Street 1:6511 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3912
Practice Address - Country:US
Practice Address - Phone:718-837-7300
Practice Address - Fax:718-837-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004631213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1182470001Medicare NSC