Provider Demographics
NPI:1831255934
Name:INCORVAIA, ANGELO NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:NICHOLAS
Last Name:INCORVAIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 HAGEN RANCH RD
Mailing Address - Street 2:SUITE A750
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:561-374-7372
Mailing Address - Fax:
Practice Address - Street 1:10301 HAGEN RANCH RD STE A750
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3725
Practice Address - Country:US
Practice Address - Phone:561-374-7372
Practice Address - Fax:561-374-8646
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-242078208600000X, 2086S0105X
FLME 981532086S0105X
NJ25MA082249002086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01367OtherBLUE CROSS BLUE SHIELD
FL01367OtherBLUE CROSS BLUE SHIELD