Provider Demographics
NPI:1730896507
Name:INSIGNARES, ANGELES
Entity type:Individual
Prefix:
First Name:ANGELES
Middle Name:
Last Name:INSIGNARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1910
Mailing Address - Country:US
Mailing Address - Phone:973-652-6511
Mailing Address - Fax:
Practice Address - Street 1:179 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1910
Practice Address - Country:US
Practice Address - Phone:973-652-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03194700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty