Provider Demographics
NPI:1790179273
Name:ANGELI, LUCILA (MD)
Entity Type:Individual
Prefix:
First Name:LUCILA
Middle Name:
Last Name:ANGELI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 BLOOMFIELD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1301
Mailing Address - Country:US
Mailing Address - Phone:973-746-7050
Mailing Address - Fax:973-857-2831
Practice Address - Street 1:799 BLOOMFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1301
Practice Address - Country:US
Practice Address - Phone:973-746-7050
Practice Address - Fax:973-857-2831
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155753207Q00000X, 208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program