MEDICARE: MICHAEL RICHARD DEANGELIS D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	185967	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	542716	OTHER	NY	AETNA
2	P746167	OTHER		OXFORD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	185967	OTHER		HIP
5	44543	OTHER		VYTRA
6	113517950	OTHER		MAGNACARE
7	6368053004	OTHER		CIGNA
8	24044	OTHER	NY	ANTHEM
9	113517950-001	OTHER		PRUDENTIAL
10	477230	OTHER		PHCS
11	00000080229	OTHER		BETTER HEALTH
12	113517950	OTHER		MULTIPLAN
13	1297667	OTHER		UNITED HEALTHCARE
14	2599070	OTHER		GHI
15	2C4152	OTHER		HEALTHNET

General Provider Information

NPI Number	:	1609962539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RICHARD DEANGELIS D.O

Provider Business Mailing Address
First Line	:	70 GLEN ST STE 380
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-2858
Country	:	US
Telephone Number	:	516-674-7074
Fax Number	:	516-674-4768

Provider Business Practice Location Address
First Line	:	70 GLEN ST STE 380
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-2858
Country	:	US
Telephone Number	:	516-674-7074
Fax Number	:	516-674-4768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	11/17/2023

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