Provider Demographics
NPI:1518149426
Name:DR WILLIAM C DEANGELO PC
Entity Type:Organization
Organization Name:DR WILLIAM C DEANGELO PC
Other - Org Name:NEUROSPINAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEANGELO PC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-878-7800
Mailing Address - Street 1:531 NEW HAVEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-878-7800
Mailing Address - Fax:203-878-8849
Practice Address - Street 1:531 NEW HAVEN AVENUE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-878-7800
Practice Address - Fax:203-878-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000912111N00000X
CT001721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty