Provider Demographics
NPI:1518334820
Name:VERDEROSA, ANGELO MICHAEL
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:MICHAEL
Last Name:VERDEROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3104
Mailing Address - Country:US
Mailing Address - Phone:631-669-4666
Mailing Address - Fax:
Practice Address - Street 1:400 UNION BLVD
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-3104
Practice Address - Country:US
Practice Address - Phone:631-942-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25433183500000X
NY066490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist