Provider Demographics
NPI:1114043650
Name:ANGELES, CARMEN M (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:ANGELES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LAUREL COURT
Mailing Address - Street 2:
Mailing Address - City:LAUREL HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:11791-1903
Mailing Address - Country:US
Mailing Address - Phone:516-692-6189
Mailing Address - Fax:
Practice Address - Street 1:51 CHARLES LINDBERGH BLVD
Practice Address - Street 2:SUITE B LABORATORY CORPORATION OF AMERICA LABCORP
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553
Practice Address - Country:US
Practice Address - Phone:516-794-4646
Practice Address - Fax:516-794-2014
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1236241207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B13007Medicare UPIN