Provider Demographics
NPI:1356827901
Name:SANT'ANGELO, ALICIA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:SANT'ANGELO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LLOYD PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2522
Mailing Address - Country:US
Mailing Address - Phone:973-444-6584
Mailing Address - Fax:
Practice Address - Street 1:1129 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3092
Practice Address - Country:US
Practice Address - Phone:973-338-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00777900225700000X
NJ25MZ00153600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist