Provider Demographics
NPI:1255330593
Name:LOUIS V. ANGIOLETTI JR. M. D., P. A.
Entity Type:Organization
Organization Name:LOUIS V. ANGIOLETTI JR. M. D., P. A.
Other - Org Name:ANGIOLETTI RETINA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANGIOLETTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-214-8140
Mailing Address - Street 1:1617 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6930
Mailing Address - Country:US
Mailing Address - Phone:800-214-8140
Mailing Address - Fax:201-947-1902
Practice Address - Street 1:1617 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6930
Practice Address - Country:US
Practice Address - Phone:800-214-8140
Practice Address - Fax:201-947-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01370034Medicaid
NJ2818809Medicaid
NJ=========OtherCIGNA INSURANCE
NJ2818809Medicaid
NJ=========OtherAETNA INSURANCE CO.
NJ=========OtherOXFORD HEALTH PLANS
NY01370034Medicaid
NJ=========OtherHORIZON HEALTH PLANS
NY01370034Medicaid