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NPI Code Detail

MEDICARE: RICHARD LAWRENCE ANGELILLO

MEDICARE: RICHARD LAWRENCE ANGELILLO
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
1235Z00000XSpeech-Language Pathologist41YS00835300NJ

General Provider Information

NPI Number : 1780192443
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD LAWRENCE ANGELILLO
Provider Business Mailing Address
First Line : 1 MAIN ST STE 505
Second Line :
City : EATONTOWN
State : NJ
Zip : 07724-3903
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 MAIN ST STE 505
Second Line :
City : EATONTOWN
State : NJ
Zip : 07724-3903
Country : US
Telephone Number : 267-471-0516
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2018
Last Update Date : 01/16/2018

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Directions to “ RICHARD LAWRENCE ANGELILLO ” Practice Location

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