Provider Demographics
NPI:1104075217
Name:ANGELO MAGNO MD PC
Entity type:Organization
Organization Name:ANGELO MAGNO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-254-4330
Mailing Address - Street 1:207 PROSPECT PARK W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8091
Mailing Address - Country:US
Mailing Address - Phone:718-434-2082
Mailing Address - Fax:516-254-4330
Practice Address - Street 1:207 PROSPECT PARK W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5797
Practice Address - Country:US
Practice Address - Phone:718-832-3200
Practice Address - Fax:718-788-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05018400207RN0300X
FLME 64504207RN0300X
NY165641207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01392438Medicaid
37F032Medicare PIN