Provider Demographics
NPI:1609962539
Name:DEANGELIS, MICHAEL RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICHARD
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GLEN ST STE 380
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2858
Mailing Address - Country:US
Mailing Address - Phone:516-674-7074
Mailing Address - Fax:516-674-4768
Practice Address - Street 1:70 GLEN ST STE 380
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2858
Practice Address - Country:US
Practice Address - Phone:516-674-7074
Practice Address - Fax:516-674-4768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY542716OtherAETNA
P746167OtherOXFORD
NY01836722Medicaid
185967OtherHIP
44543OtherVYTRA
113517950OtherMAGNACARE
6368053004OtherCIGNA
NY24044OtherANTHEM
113517950-001OtherPRUDENTIAL
477230OtherPHCS
00000080229OtherBETTER HEALTH
113517950OtherMULTIPLAN
1297667OtherUNITED HEALTHCARE
2599070OtherGHI
2C4152OtherHEALTHNET
6368053004OtherCIGNA
185967OtherHIP