Provider Demographics
NPI:1164463808
Name:DEANGELIS, TERESA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIA
Last Name:DEANGELIS
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 1:1991 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2057
Mailing Address - Country:US
Mailing Address - Phone:516-466-4700
Mailing Address - Fax:516-466-4810
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:BOX 1138
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-6854
Practice Address - Fax:212-241-5333
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230555-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00230555Medicaid
NY723C37WYX1Medicare Oscar/Certification