Provider Demographics
NPI:1629330113
Name:ANGELMARC, LLC
Entity Type:Organization
Organization Name:ANGELMARC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEVINCENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:718-447-4061
Mailing Address - Street 1:263 FISKE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3138
Mailing Address - Country:US
Mailing Address - Phone:718-447-4061
Mailing Address - Fax:
Practice Address - Street 1:263 FISKE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3138
Practice Address - Country:US
Practice Address - Phone:718-447-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty