Provider Demographics
NPI:1316030364
Name:D'ANGELO, ENRICO (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRICO
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 BUHRE AVE
Mailing Address - Street 2:PARKVIEW PROFESSIONAL BLDG
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4738
Mailing Address - Country:US
Mailing Address - Phone:718-409-2762
Mailing Address - Fax:718-863-4432
Practice Address - Street 1:3117 BUHRE AVE
Practice Address - Street 2:PARKVIEW PROFESSIONAL BLDG
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4738
Practice Address - Country:US
Practice Address - Phone:718-409-2762
Practice Address - Fax:718-863-4432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY158217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63939Medicare UPIN
NY71D511Medicare PIN