Healthcare Provider Details

I. General information

NPI: 1124105002
Provider Name (Legal Business Name): GEORGE D. DANGAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVENUE
NEW YORK NY
10032
US

IV. Provider business mailing address

630 WEST 168TH STREET
NEW YORK NY
10032-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1540
  • Fax: 212-410-7196
Mailing address:
  • Phone: 212-427-1540
  • Fax: 212-410-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number001090
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number001090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: