Provider Demographics
NPI:1982975041
Name:DEANGELIS, VINCENT ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ROBERT
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:88 MEADOWFARM RD
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2909
Mailing Address - Country:US
Mailing Address - Phone:631-581-4250
Mailing Address - Fax:631-581-3993
Practice Address - Street 1:88 MEADOWFARM RD
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2909
Practice Address - Country:US
Practice Address - Phone:631-581-4250
Practice Address - Fax:631-581-3993
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082537-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF18070OtherUPIN