Jack Basil Dangelo Jr., M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

195391 Issued in NY

Practice address

191 Bradley Ave
Staten Island, NY 10314-5166

Phone

(917) 748-8341

Fax

(917) 970-9703

NPI assigned

Feb 14, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jack Basil D'Angelo Other name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jack Basil Dangelo Jr

  • Physical Medicine & Rehabilitation Physician
  • Staten Island, NY
  • NPI 1972236131
  NPD Authorized official
• Aqua Pura Limited Liability Company

  • Physical Therapy Clinic/Center
  • Staten Island, NY
  • NPI 1811528151
  NPD (past) Authorized official
• Amboy Medical Practice PC

  • Diagnostic Radiology Physician
  • Staten Island, NY
  • NPI 1104692672
  NPD (past)
• Amboy Medical Practice PC

  • Internal Medicine Physician
  • Staten Island, NY
  • NPI 1700037975
  NPD (past)
• Richmond University Medical Center

  • Multi-Specialty Clinic/Center
  • Staten Island, NY
  • NPI 1811054042
  NPD (past)
• Staten Island Physician Practice PC

  dba AdvantageCare Physicians

  • Internal Medicine Physician
  • New York, NY
  • NPI 1568413169
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1245204650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 CARPENDER RD",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011501",
            "telephone_number": "732-545-5771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 BRADLEY AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103145166",
            "telephone_number": "917-748-8341",
            "fax_number": "917-970-9703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "361 Edison St",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103063043",
            "country_code": "US",
            "telephone_number": "718-980-0101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DANGELO",
        "first_name": "JACK",
        "middle_name": "BASIL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "195391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01484220",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "D'ANGELO",
            "middle_name": "BASIL",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Briana Damora, FNP
• Gardenia Gloria Danao-Villamor, PT
• Efstathia Joanne Danas, SLP
• Danial Daneshvar, M.D
• Suveera Dang, MD
• Mona Danial
• Daniel J Paulo MD PC
• Daniel Kaye
• Jeanne Daniel
• Prince Daniel, PA

• Physical Medicine & Rehabilitation Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.