Healthcare Provider Details

I. General information

NPI: 1831255934
Provider Name (Legal Business Name): ANGELO NICHOLAS INCORVAIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HAGEN RANCH RD STE A750
BOYNTON BEACH FL
33437-3725
US

IV. Provider business mailing address

10301 HAGEN RANCH RD SUITE A750
BOYNTON BEACH FL
33437
US

V. Phone/Fax

Practice location:
  • Phone: 561-374-7372
  • Fax: 561-374-8646
Mailing address:
  • Phone: 561-374-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number60-242078
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number60-242078
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberME 98153
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number25MA08224900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: