MEDICARE: ANGELIC HEALTH PRACTICE GROUP

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	1041C0700X	Clinical Social Worker
2	363LC1500X	Community Health Nurse Practitioner

General Provider Information

NPI Number	:	1891448064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HEALTH PRACTICE GROUP

Provider Business Mailing Address
First Line	:	8025 BLACK HORSE PIKE STE 501
Second Line	:
City	:	PLEASANTVILLE
State	:	NJ
Zip	:	08232-2967
Country	:	US
Telephone Number	:	609-822-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	923C MEDICAL CIRCLE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572
Country	:	US
Telephone Number	:	843-356-9078
Fax Number	:	843-356-4086

Authorized Official
Title or Position	:	CEO
Name	:	DAN MIKUS
Credential	:
Telephone Number	:	609-822-7979

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	01/12/2024

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Directions to “ANGELIC HEALTH PRACTICE GROUP ” Practice Location

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