Moris Alejandro Angulo, M.D.
Individual provider Active NPI Pediatric Endocrinology Physician · Mineola, NY
NPI 1477573269 · NPPES record last updated May 4, 2021
Key facts
- NPI
- 1477573269
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Endocrinology Physician 2080P0205X
- License
- 159613 (NY)
- Practice address
- 120 Mineola Blvd
Suite 210
Mineola, NY 11501-4073 - Phone
- (516) 663-3090
- Fax
- (516) 663-3070
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Other, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Samaritan Pediatric Services PC
Practice addresses (Care Compare)
655 Deer Park Ave
Babylon, NY 11702-1314
Phone (631) 321-2100
Hospital & facility affiliations
- Good Samaritan Hospital Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080326000421 | NY | Practitioner - Pediatric Medicine | 0749366169 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 159613 | NY | MD | Clinical Genetics (M.D.) Physician |
Practice roles (3 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New York University | Current |
Accepting new patients | |
| Samaritan Pediatric Services, P.C. | Current |
Accepting new patients | |
| New York University | Current |
Accepting new patients |
Locations
655 Deer Park Ave
Babylon, NY 11702
Phone (631) 321-2100
340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064
101 Mineola Blvd
Fl 2
Mineola, NY 11501
Phone (516) 633-3511
222 Station Plz N
Ste 611
Mineola, NY 11501
Phone (516) 663-2532
120 Mineola Blvd
Ste 210
Mineola, NY 11501
Phone (516) 663-4600
1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
Interoperability endpoints
- mangulo81653@direct-chsli.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Genetics (M.D.) Physician | 207SG0201X | 159613 | NY | |
| Pediatric Endocrinology Physician | 2080P0205X | 159613 | NY | Yes |
Addresses
Primary practice location
120 Mineola Blvd
Suite 210
Mineola, NY 11501-4073
Mailing address
222 Station PLZ N
Suite 611
Mineola, NY 11501-3808
Phone (516) 663-2532
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01244435 | Medicaid | NY |
Other providers in Mineola, NY
- Alejandro Manuel Andrade-Vicenty
- Cynthia Andrade
- Andrew Sackserdds PLLC
- Janna Andrews
- Alyssa Rose Angelillo
- Shaiba Anil
- Abel Aniyankunju
- Christopher Naser Annabi
- Karin A. Antaky
- Ronny Antony
All providers in Mineola, NY · Pediatric Endocrinology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.