Healthcare Provider Details

I. General information

NPI: 1114837630
Provider Name (Legal Business Name): MR. ANGELO MARCELLUS WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W 125TH ST APT 4B
NEW YORK NY
10027-4269
US

IV. Provider business mailing address

439 W 125TH ST APT 4B
NEW YORK NY
10027-4269
US

V. Phone/Fax

Practice location:
  • Phone: 718-722-6033
  • Fax: 718-722-6189
Mailing address:
  • Phone: 718-722-6033
  • Fax: 718-722-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: