Provider Demographics
NPI:1164422796
Name:MAGNO, ANGELO L (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:L
Last Name:MAGNO
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 1:551 E 24TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1129
Mailing Address - Country:US
Mailing Address - Phone:718-434-2082
Mailing Address - Fax:718-434-3636
Practice Address - Street 1:207 PROSPECT PARK W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5797
Practice Address - Country:US
Practice Address - Phone:718-832-3200
Practice Address - Fax:718-788-5419
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2016-09-22
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY165641207RN0300X
NJ25MA05018400207RN0300X
FLME 64504207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01392438Medicaid
NY1104075217Medicare NSC
NY37F032Medicare ID - Type UnspecifiedMCR 02
NY1164422796Medicare NSC