=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578727194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABRIEL F. DEANGELIS MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2008
-----------------------------------------------------
Last Update Date | 09/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16215 HIGHLAND AVE 1F
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-657-8171
-----------------------------------------------------
Fax | 718-657-0548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16215 HIGHLAND AVE 1F
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-657-8171
-----------------------------------------------------
Fax | 718-657-0548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GABRIEL FRANCIS DEANGELIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-657-8171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 099931
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------