Provider Demographics
NPI:1437240017
Name:LOIACONO, ANGELA A (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:LOIACONO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1772
Mailing Address - Country:US
Mailing Address - Phone:845-628-3805
Mailing Address - Fax:845-628-3833
Practice Address - Street 1:925 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1772
Practice Address - Country:US
Practice Address - Phone:845-628-3805
Practice Address - Fax:845-628-3833
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX8501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB0536Medicare ID - Type Unspecified
U70199Medicare UPIN