Provider Demographics
NPI:1467674887
Name:AIELLO, ANGELO (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:
Last Name:AIELLO
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4337 KEPLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470
Mailing Address - Country:US
Mailing Address - Phone:718-994-3842
Mailing Address - Fax:
Practice Address - Street 1:603 EAST 187TH STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1815
Practice Address - Country:US
Practice Address - Phone:718-994-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002464-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant