Provider Demographics
NPI:1790755718
Name:ASSOCIATES IN NEONATOLOGY, P.A.
Entity Type:Organization
Organization Name:ASSOCIATES IN NEONATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEOGRACIAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAANGAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-343-6906
Mailing Address - Street 1:9981 S HEALTHPARK DR
Mailing Address - Street 2:SUITE 281
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3618
Mailing Address - Country:US
Mailing Address - Phone:239-343-6906
Mailing Address - Fax:239-343-6915
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:SUITE 281
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3618
Practice Address - Country:US
Practice Address - Phone:239-343-6906
Practice Address - Fax:239-343-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97376OtherBLUE CROSS GROUP NUMBER
FL054262802Medicaid
FL054262800Medicaid