Provider Demographics
NPI:1821613191
Name:COLANGELO, CASEY ANN (PA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN
Last Name:COLANGELO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHERI DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1119
Mailing Address - Country:US
Mailing Address - Phone:201-739-6699
Mailing Address - Fax:
Practice Address - Street 1:1075 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1116
Practice Address - Country:US
Practice Address - Phone:732-574-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant