Provider Demographics
NPI:1164711057
Name:DAVID L. CANGELLO, MD PLLC
Entity Type:Organization
Organization Name:DAVID L. CANGELLO, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:CANGELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-644-4416
Mailing Address - Street 1:66 E 55TH ST
Mailing Address - Street 2:SIXTH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3206
Mailing Address - Country:US
Mailing Address - Phone:212-644-4416
Mailing Address - Fax:646-786-4423
Practice Address - Street 1:66 E 55TH ST
Practice Address - Street 2:SIXTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3206
Practice Address - Country:US
Practice Address - Phone:212-644-4416
Practice Address - Fax:646-786-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243450208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689813685OtherINDIVIDUAL NPI
1689813685OtherINDIVIDUAL NPI