Healthcare Provider Details

I. General information

NPI: 1134990708
Provider Name (Legal Business Name): ANGELIC HEALTH PRACTICE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 NORRISTOWN RD STE 133B
BLUE BELL PA
19422-2353
US

IV. Provider business mailing address

8025 BLACK HORSE PIKE STE 501
PLEASANTVILLE NJ
08232-2967
US

V. Phone/Fax

Practice location:
  • Phone: 844-929-0225
  • Fax:
Mailing address:
  • Phone: 856-812-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN MIKUS
Title or Position: CEO
Credential:
Phone: 609-822-7979