Provider Demographics
NPI:1972592293
Name:MCCOMISKEY & CANGELOSI II, L.L.C.
Entity Type:Organization
Organization Name:MCCOMISKEY & CANGELOSI II, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANGELOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-871-0070
Mailing Address - Street 1:604 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3308
Mailing Address - Country:US
Mailing Address - Phone:985-871-0070
Mailing Address - Fax:985-871-0046
Practice Address - Street 1:604 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3308
Practice Address - Country:US
Practice Address - Phone:985-871-0070
Practice Address - Fax:985-871-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADE7701OtherRAILROAD MEDICARE
LA1449393Medicaid
LA5CU15Medicare PIN
LADE7701OtherRAILROAD MEDICARE