Healthcare Provider Details

I. General information

NPI: 1780680876
Provider Name (Legal Business Name): ANGELO G BELLARDINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 MCBRIDE AVENUE
WEST PATERSON NJ
07424
US

IV. Provider business mailing address

1225 MCBRIDE AVE
WOODLAND PARK NJ
07424-3812
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-5557
  • Fax: 973-256-5036
Mailing address:
  • Phone: 973-256-5557
  • Fax: 973-256-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA03900500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: