Individual
DR. JACK BASIL DANGELO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
191 BRADLEY AVE, STATEN ISLAND, NY 10314-5166
(917) 748-8341
(917) 970-9703
Mailing address
3 CARPENDER RD, NEW BRUNSWICK, NJ 08901-1501
(732) 545-5771
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
195391
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01484220
—
NY
Enumeration date
02/14/2006
Last updated
08/03/2022
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