Healthcare Provider Details

I. General information

NPI: 1497526065
Provider Name (Legal Business Name): ANGELIC HEALTH PRACTICE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 BLACK HORSE PIKE STE 501
PLEASANTVILLE NJ
08232-2967
US

IV. Provider business mailing address

8025 BLACK HORSE PIKE STE 501
PLEASANTVILLE NJ
08232-2967
US

V. Phone/Fax

Practice location:
  • Phone: 609-464-1135
  • Fax:
Mailing address:
  • Phone: 856-812-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN MIKUS
Title or Position: CEO
Credential:
Phone: 609-822-7979