Organization
JACK BASIL DANGELO JR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK D'ANGELO MD (PRESIDENT)
(917) 748-8341
Entity
Organization
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
(917) 748-8341
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01484220
—
NY
Enumeration date
07/06/2022
Last updated
07/06/2022
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