Provider Demographics
NPI:1760481030
Name:ANGIOLETTI, LOUIS S (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:S
Last Name:ANGIOLETTI
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 1:55 5TH AVE STE 1801
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4301
Mailing Address - Country:US
Mailing Address - Phone:212-691-4200
Mailing Address - Fax:212-646-1964
Practice Address - Street 1:55 5TH AVE STE 1801
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4301
Practice Address - Country:US
Practice Address - Phone:212-691-4200
Practice Address - Fax:646-809-1964
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172831207WX0107X
NY172831-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01369960Medicaid
NJ494489OtherAETNA INSURANCE CO.
NJOC5518OtherHEALTHNET INSURANCE CO.
NJ6142001Medicaid
NJBS498OtherOXFORD HEALTH PLANS
NY497561OtherAETNA INSURANCE CO.
NY01369960Medicaid
NJBS498OtherOXFORD HEALTH PLANS
NY497561OtherAETNA INSURANCE CO.