Provider Demographics
NPI:1962551499
Name:PILLA, ANGELO G (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:G
Last Name:PILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E 22ND ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5404
Mailing Address - Country:US
Mailing Address - Phone:212-228-8558
Mailing Address - Fax:212-228-5582
Practice Address - Street 1:102 E 22ND ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5404
Practice Address - Country:US
Practice Address - Phone:212-228-8558
Practice Address - Fax:212-228-5582
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY171746207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY29F331Medicare ID - Type Unspecified
NYE87255Medicare UPIN