Provider Demographics
NPI:1689682619
Name:AGUILERA, ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-08 JUSTICE AVE
Mailing Address - Street 2:SUITE CM
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:718-507-2000
Mailing Address - Fax:718-507-2358
Practice Address - Street 1:87-08 JUSTICE AVE
Practice Address - Street 2:SUITE CM
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-507-2000
Practice Address - Fax:718-507-2358
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01961100Medicaid
H14346Medicare UPIN
NY04010Medicare ID - Type Unspecified