Provider Demographics
NPI:1881766111
Name:DEANGELIS, RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FLETCHER AVE 7
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4000
Mailing Address - Country:US
Mailing Address - Phone:516-637-8963
Mailing Address - Fax:516-872-1091
Practice Address - Street 1:125 FRANKLIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2165
Practice Address - Country:US
Practice Address - Phone:516-872-0430
Practice Address - Fax:516-887-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006905-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX67811Medicare ID - Type Unspecified