1003909755 NPI number — ANGELA GLASSCOCK NP

Table of content: ANGELA GLASSCOCK NP (NPI 1003909755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003909755 NPI number — ANGELA GLASSCOCK NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASSCOCK
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003909755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 BROADWAY, DEPARTMENT OF PEDIATRICS 2B321
Provider Second Line Business Mailing Address:
WOODHULL MEDICAL & MENTAL HEALTH CENTER
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-963-8214
Provider Business Mailing Address Fax Number:
718-630-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 NORTH PORTLAND AVENUE
Provider Second Line Business Practice Location Address:
CUMBERLAND DIAGNOSTIC & TREATMENT CENTER
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-260-7500
Provider Business Practice Location Address Fax Number:
718-630-3122
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  F380947 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00246075 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".