Provider Demographics
NPI:1154692218
Name:DEANGELIS, JEANNETTE L (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:L
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:88 MEADOWFARM RD
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2909
Mailing Address - Country:US
Mailing Address - Phone:631-921-5341
Mailing Address - Fax:631-581-3993
Practice Address - Street 1:88 MEADOWFARM RD
Practice Address - Street 2:SANJURJO@OPTONLINE.NET
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2909
Practice Address - Country:US
Practice Address - Phone:631-921-5341
Practice Address - Fax:631-581-3993
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
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Provider Licenses
StateLicense IDTaxonomies
NY086574-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology