Healthcare Provider Details

I. General information

NPI: 1760481030
Provider Name (Legal Business Name): LOUIS S ANGIOLETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 5TH AVE STE 1801
NEW YORK NY
10003-4301
US

IV. Provider business mailing address

55 5TH AVE STE 1801
NEW YORK NY
10003-4301
US

V. Phone/Fax

Practice location:
  • Phone: 212-691-4200
  • Fax: 646-809-1964
Mailing address:
  • Phone: 212-691-4200
  • Fax: 212-646-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number25MA05776200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number172831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: