Provider Demographics
NPI:1710948583
Name:ANGELASTRO, DAVID BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:ANGELASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E NEW YORK AVE
Mailing Address - Street 2:BAYFRONT EMERGENCY PHYSICIANS PA
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2340
Mailing Address - Country:US
Mailing Address - Phone:609-653-3519
Mailing Address - Fax:609-653-3247
Practice Address - Street 1:1 E NEW YORK AVENUE
Practice Address - Street 2:SHORE MEMORIAL HOSPITAL
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-653-3159
Practice Address - Fax:609-653-3247
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06709000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7613806Medicaid
NJ7613806Medicaid
NJ013412Medicare ID - Type Unspecified