Healthcare Provider Details

I. General information

NPI: 1730051848
Provider Name (Legal Business Name): ANGELO D DASILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PARK AVE
NEW YORK NY
10128-1711
US

IV. Provider business mailing address

31 HASTINGS AVE
RUTHERFORD NJ
07070-1801
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-5300
  • Fax:
Mailing address:
  • Phone: 201-341-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406847-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: