Provider Demographics
NPI:1336558162
Name:EMILE I. RANGEL, MD, LLC
Entity Type:Organization
Organization Name:EMILE I. RANGEL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-240-2707
Mailing Address - Street 1:4501 PALISADE AVE., APT. 10B
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-240-2707
Mailing Address - Fax:
Practice Address - Street 1:6804 BERGENLINE AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07093-1826
Practice Address - Country:US
Practice Address - Phone:201-240-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066179261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care