Provider Demographics
NPI:1447322417
Name:COLANGELO, PETER (OD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:COLANGELO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PATRICIA WAY
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1806
Mailing Address - Country:US
Mailing Address - Phone:732-398-1354
Mailing Address - Fax:
Practice Address - Street 1:3535 US HIGHWAY 1
Practice Address - Street 2:PRINCETON MARKETFAIR SUITE 400
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5903
Practice Address - Country:US
Practice Address - Phone:609-520-1008
Practice Address - Fax:609-520-9279
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 4458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist