Provider Demographics
NPI:1720185879
Name:SANTANGELO III, DONATO (MD)
Entity Type:Individual
Prefix:
First Name:DONATO
Middle Name:
Last Name:SANTANGELO III
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 1:462 LAKEHURST RD STE A
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6345
Mailing Address - Country:US
Mailing Address - Phone:732-244-2706
Mailing Address - Fax:732-244-2556
Practice Address - Street 1:462 LAKEHURST RD STE A
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6345
Practice Address - Country:US
Practice Address - Phone:732-244-2706
Practice Address - Fax:732-244-2556
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04651500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ166676B06Medicare ID - Type UnspecifiedRENDERING
NJE53436Medicare UPIN
NJ166676Medicare ID - Type UnspecifiedRENDERING