Provider Demographics
NPI:1417984659
Name:CHINNICI, ANGELO A (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:A
Last Name:CHINNICI
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 1:601 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5313
Mailing Address - Country:US
Mailing Address - Phone:732-775-7978
Mailing Address - Fax:732-988-2545
Practice Address - Street 1:601 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5313
Practice Address - Country:US
Practice Address - Phone:732-775-7978
Practice Address - Fax:732-988-2545
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH583855Medicare ID - Type Unspecified
C57398Medicare UPIN