Provider Demographics
NPI:1194839027
Name:DEANGELO, ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:DEANGELO
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 1:215 OLD TAPPAN ROAD
Mailing Address - Street 2:OLD TAPPAN PEDIATRICS
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-1000
Mailing Address - Fax:201-666-7610
Practice Address - Street 1:215 OLD TAPPAN ROAD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-1000
Practice Address - Fax:201-666-7610
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAU62559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5757028OtherAETNA
221941517004OtherPRUDENTIAL
551957OtherUSHC
010062559NJ01OtherANTHEM HEALTI
56U101OtherEMPIRE HLTHCR
NJ7909501Medicaid
1542817OtherUNITED HLTHCR
F01399OtherHEALTHNET
23719OtherMASTERCARE
83303OtherAMERIGROUP
9167343002OtherCIGNA
998602OtherREFERRAL
P377160OtherOXFORD
998602OtherREFERRAL
9167343002OtherCIGNA