Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Jack Basil Dangelo Jr., MD

Individual provider Physical Medicine & Rehabilitation Physician · NPI 1245204650

Dr. Jack Basil Dangelo Jr., MD is a Physical Medicine & Rehabilitation Physician in Staten Island, New York. Practices as a sole proprietor and works from 2 locations. Licensed in New York.

Licensed in
NY
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

191 Bradley Ave
Staten Island, NY 10314-5166
Phone: (917) 748-8341
Fax: (917) 970-9703
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 361 Edison St, Staten Island, NY 10306-3043 — (718) 980-0101

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X · Licence 195391 (NY)

Record details

NPI number1245204650
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedFebruary 14, 2006
Last updated in NPPESAugust 3, 2022
Certification dateAugust 3, 2022

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