Provider Demographics
NPI:1649567207
Name:CARANGELO, ALEXANDER (RPAC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:CARANGELO
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 NEW SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9386
Mailing Address - Country:US
Mailing Address - Phone:518-439-4326
Mailing Address - Fax:518-439-6143
Practice Address - Street 1:83 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2472
Practice Address - Country:US
Practice Address - Phone:315-792-7629
Practice Address - Fax:315-266-1326
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014840363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400084120Medicare PIN