Provider Demographics
NPI:1396790648
Name:D'ANGELO, NICHOLAS (DPM)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3912
Mailing Address - Country:US
Mailing Address - Phone:718-837-7300
Mailing Address - Fax:718-837-6674
Practice Address - Street 1:6511 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3912
Practice Address - Country:US
Practice Address - Phone:718-837-7300
Practice Address - Fax:718-837-6674
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004631213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01180652Medicaid
NY01180652Medicaid
NYP51161Medicare ID - Type Unspecified