Provider Demographics
NPI:1912195025
Name:DR. ANGELO J. AIELLO
Entity Type:Organization
Organization Name:DR. ANGELO J. AIELLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:AIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-461-0987
Mailing Address - Street 1:2910 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-2522
Mailing Address - Country:US
Mailing Address - Phone:856-461-0987
Mailing Address - Fax:856-231-9038
Practice Address - Street 1:2910 ROUTE 130
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2522
Practice Address - Country:US
Practice Address - Phone:856-461-0987
Practice Address - Fax:856-368-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00394000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1126806Medicaid
NJ681618Medicare PIN
NJ1126806Medicaid