Healthcare Provider Details

I. General information

NPI: 1801882337
Provider Name (Legal Business Name): JOHN D'ANGELO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

563 VIA GENOVA
DEERFIELD BEACH FL
33442-8627
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5000
  • Fax: 732-923-2272
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB08853100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS9607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: