Provider Demographics
NPI:1255847182
Name:PILOSOV, ANGELA
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:PILOSOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 59TH AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3825
Mailing Address - Country:US
Mailing Address - Phone:917-929-4105
Mailing Address - Fax:
Practice Address - Street 1:2903 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2202
Practice Address - Country:US
Practice Address - Phone:718-463-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008748-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician