Provider Demographics
NPI:1346498714
Name:MICHAEL DEANGELIS DO PC
Entity Type:Organization
Organization Name:MICHAEL DEANGELIS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO PC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-674-7074
Mailing Address - Street 1:70 GLEN ST STE 380
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2858
Mailing Address - Country:US
Mailing Address - Phone:516-674-7074
Mailing Address - Fax:516-674-4768
Practice Address - Street 1:70 GLEN ST STE 380
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2858
Practice Address - Country:US
Practice Address - Phone:516-674-7074
Practice Address - Fax:516-674-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000190Medicare PIN