Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 158780 | NY |
NPI | 1013081363 |
---|---|
Provider Name | Angela Tangredi |
First Address | Nanuet, NY 10954-5288 |
Second Address | New York, NY 10019-1147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01747819 | (05) | NY |