Provider Demographics
NPI:1780192955
Name:GAO, ANGELA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:YANGZI
Other - Middle Name:
Other - Last Name:GAOXIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1925
Mailing Address - Country:US
Mailing Address - Phone:917-714-2227
Mailing Address - Fax:
Practice Address - Street 1:300 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-788-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006175171100000X
NJ25MZ00130500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist