Provider Demographics
NPI:1356314751
Name:ADELIZZI, ANGELA M (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:ADELIZZI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2975
Mailing Address - Country:US
Mailing Address - Phone:732-349-4994
Mailing Address - Fax:
Practice Address - Street 1:1314 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2975
Practice Address - Country:US
Practice Address - Phone:732-349-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05470500207R00000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K5129OtherHEALTHNET
NJ223360408-039OtherQUALCARE
NJ110202552OtherRR MEDICARE
NJ7342306Medicaid
NJP2017335OtherOXFORD
NJP2017335OtherOXFORD
NJF25061Medicare UPIN