MEDICARE: ANGELIC CARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	25MA08523700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457623886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC CARE CENTER LLC

Provider Business Mailing Address
First Line	:	1102 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	718-447-5072
Fax Number	:	718-447-5178

Provider Business Practice Location Address
First Line	:	637 GEORGES RD
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3331
Country	:	US
Telephone Number	:	732-246-8905
Fax Number	:	718-447-5178

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MARY B GALVIN
Credential	:	M.D.
Telephone Number	:	732-246-8905

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/01/2012

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Directions to “ANGELIC CARE CENTER LLC ” Practice Location

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