Provider Demographics
NPI:1144755893
Name:ANGELOTTI, JOSEPH W (LMT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:ANGELOTTI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NATHANIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1812
Mailing Address - Country:US
Mailing Address - Phone:518-288-7440
Mailing Address - Fax:
Practice Address - Street 1:15 NATHANIEL BLVD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1812
Practice Address - Country:US
Practice Address - Phone:518-288-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027398-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist