Healthcare Provider Details

I. General information

NPI: 1659070688
Provider Name (Legal Business Name): LORANGEL ANTONIO CANDELARIO REGISTERED NURSE, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANTONIO CANDELARIO

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 PELHAM PKWY S
BRONX NY
10462
US

IV. Provider business mailing address

754 PELHAM PKWY S
BRONX NY
10462-1032
US

V. Phone/Fax

Practice location:
  • Phone: 646-406-7273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number849419
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR24518800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number849419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: