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Organization

AQUA PURA LIMITED LIABILITY COMPANY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JACK D'ANGELO MD (OWNER/PRESIDENT)
(917) 748-8341
Entity
Organization

Contact information

Practice address
191 BRADLEY AVE, STATEN ISLAND, NY 10314-5166
(917) 748-8341
Mailing address
3 CARPENDER RD, NEW BRUNSWICK, NJ 08901-1501
(732) 545-5771

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
195391
LICENSE
NY
Enumeration date
01/27/2020
Last updated
01/27/2020
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