Healthcare Provider Details

I. General information

NPI: 1477573269
Provider Name (Legal Business Name): MORIS ALEJANDRO ANGULO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MINEOLA BLVD SUITE 210
MINEOLA NY
11501-4073
US

IV. Provider business mailing address

222 STATION PLZ N SUITE 611
MINEOLA NY
11501-3808
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-3090
  • Fax: 516-663-3070
Mailing address:
  • Phone: 516-663-2532
  • Fax: 516-663-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number159613
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number159613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: