Provider Demographics
NPI:1366476939
Name:ANG, LUIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:C
Last Name:ANG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7004 BLVD.EAST
Mailing Address - Street 2:9M
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5009
Mailing Address - Country:US
Mailing Address - Phone:201-869-2732
Mailing Address - Fax:201-869-2732
Practice Address - Street 1:260 E 188TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5302
Practice Address - Country:US
Practice Address - Phone:718-960-0444
Practice Address - Fax:718-933-8208
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
NY1690002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02100690Medicaid