Individual
EVAN ANGELO ANGELIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
177 FORT WASHINGTON AVE, NEW YORK, NY 10032-3733
(212) 305-2500
Mailing address
108 WOLF AVE, MALVERNE, NY 11565-1524
(516) 662-8857
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
019920
NY
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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