Provider Demographics
NPI:1750474946
Name:BIASE, ANGELO M (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:M
Last Name:BIASE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2016
Mailing Address - Country:US
Mailing Address - Phone:631-289-3067
Mailing Address - Fax:631-289-3027
Practice Address - Street 1:157 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2016
Practice Address - Country:US
Practice Address - Phone:631-289-3067
Practice Address - Fax:631-289-3027
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0084991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X97181Medicare ID - Type Unspecified