Provider Demographics
NPI:1508426768
Name:DR DAVID ANGELILLO ORTHOPAEDIC SURGERY & SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:DR DAVID ANGELILLO ORTHOPAEDIC SURGERY & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-348-1498
Mailing Address - Street 1:148 EARL ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2945
Mailing Address - Country:US
Mailing Address - Phone:516-348-1498
Mailing Address - Fax:
Practice Address - Street 1:20001 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3223
Practice Address - Country:US
Practice Address - Phone:718-971-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116864OtherLICENSE