Provider Demographics
NPI:1285146472
Name:DANGELO, CHARLENE ANN
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:ANN
Last Name:DANGELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:ANN
Other - Last Name:RAGIMIERSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:164 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-5401
Mailing Address - Country:US
Mailing Address - Phone:631-312-4446
Mailing Address - Fax:
Practice Address - Street 1:14 RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3453
Practice Address - Country:US
Practice Address - Phone:631-722-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist