Healthcare Provider Details

I. General information

NPI: 1073531471
Provider Name (Legal Business Name): ANDREW (DREW) CANGELOSI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 ORCHARD ST
WESTFIELD NJ
07090-3133
US

IV. Provider business mailing address

261 ORCHARD ST
WESTFIELD NJ
07090-3133
US

V. Phone/Fax

Practice location:
  • Phone: 908-654-6500
  • Fax: 908-654-6645
Mailing address:
  • Phone: 908-654-6500
  • Fax: 908-654-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3118
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: