Provider Demographics
NPI:1376056804
Name:ANGEL THERAPIES, INC.
Entity Type:Organization
Organization Name:ANGEL THERAPIES, INC.
Other - Org Name:ANGEL THERAPIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOURAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-284-4268
Mailing Address - Street 1:14550 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3031
Mailing Address - Country:US
Mailing Address - Phone:917-284-4268
Mailing Address - Fax:
Practice Address - Street 1:14550 19TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3031
Practice Address - Country:US
Practice Address - Phone:917-284-4268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY893476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty