Provider Demographics
NPI:1477820066
Name:MASTROPASQUA, ANGELO JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:JOSEPH
Last Name:MASTROPASQUA
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 1:353 E 17TH ST
Mailing Address - Street 2:APT 14A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:353 E 17TH ST
Practice Address - Street 2:APT 14A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3821
Practice Address - Country:US
Practice Address - Phone:631-379-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256905-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology