Healthcare Provider Details

I. General information

NPI: 1497152102
Provider Name (Legal Business Name): GIOVANNI ANGELINO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

PO BOX 697
GOLDENS BRIDGE NY
10526-0697
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-1393
  • Fax: 914-232-1395
Mailing address:
  • Phone: 914-232-1393
  • Fax: 914-232-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number205462
License Number StateNY

VIII. Authorized Official

Name: DR. GIOVANNI ANGELINO
Title or Position: PRESIDENT
Credential: MD
Phone: 914-232-1393