Provider Demographics
NPI:1265531875
Name:ANGEROSA JR., JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ANGEROSA JR.
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6022
Mailing Address - Country:US
Mailing Address - Phone:518-346-1286
Mailing Address - Fax:518-346-3610
Practice Address - Street 1:1545 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6022
Practice Address - Country:US
Practice Address - Phone:518-346-1286
Practice Address - Fax:518-346-3610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113280207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314425Medicaid
NY53521AMedicare ID - Type Unspecified
NY00314425Medicaid