Dangelo, Jack Basil

Dangelo, Jack Basil is an sole proprietor health care provider with primary practice located at 191 Bradley Ave , Staten Island NY 10314-5166. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Dangelo, Jack Basil can be contacted via phone (917) 748-8341.

Contact Information

Primary practice address
191 Bradley Ave Staten Island NY 10314-5166
Phone: (917) 748-8341
Fax: (917) 970-9703
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 195391 New York

Profile Details

NPI number 1245204650
LBN Legal business name Dangelo, Jack Basil
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 14th, 2006
Last updated Aug 3rd, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245204650 NPPES
New York MEDICAID 01484220

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