Healthcare Provider Details

I. General information

NPI: 1720721277
Provider Name (Legal Business Name): MICHAEL ANGELA OMONGOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA OMONGOS

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL STE 205
ENGLEWOOD NJ
07631-4959
US

IV. Provider business mailing address

25 ROCKWOOD PL STE 205
ENGLEWOOD NJ
07631-4959
US

V. Phone/Fax

Practice location:
  • Phone: 201-292-1400
  • Fax:
Mailing address:
  • Phone: 201-292-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA13227600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number340679-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: