Healthcare Provider Details

I. General information

NPI: 1770127706
Provider Name (Legal Business Name): DENISE DEANGELO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W OLD COUNTRY RD STE 201
HICKSVILLE NY
11801-4036
US

IV. Provider business mailing address

499 CHESMAN ST
WEST HEMPSTEAD NY
11552-1817
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-9677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027380
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number027380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: