Healthcare Provider Details

I. General information

NPI: 1205923661
Provider Name (Legal Business Name): RONALD ANGOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR SUITE 105
NEW HAVEN CT
06511-5991
US

IV. Provider business mailing address

1 LONG WHARF DR SUITE 105
NEW HAVEN CT
06511-5991
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-3737
  • Fax: 203-624-0751
Mailing address:
  • Phone: 203-865-3737
  • Fax: 203-624-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number017168
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: