Healthcare Provider Details

I. General information

NPI: 1487681250
Provider Name (Legal Business Name): FREDRICK RICHARD SANTANGELO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEATHER DR
EAST HANOVER NJ
07936-3203
US

IV. Provider business mailing address

1 HEATHER DR
EAST HANOVER NJ
07936-3203
US

V. Phone/Fax

Practice location:
  • Phone: 973-428-8244
  • Fax: 973-428-8123
Mailing address:
  • Phone: 973-428-8244
  • Fax: 973-428-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00181400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00181400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00181400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: