1073505285 NPI number — MS. ANGELINA M MISENO-CALLAGHAN RPA-C

Table of content: MS. ANGELINA M MISENO-CALLAGHAN RPA-C (NPI 1073505285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073505285 NPI number — MS. ANGELINA M MISENO-CALLAGHAN RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISENO-CALLAGHAN
Provider First Name:
ANGELINA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMINO
Provider Other First Name:
ANGELINA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073505285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTTVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14731-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-699-9032
Provider Business Mailing Address Fax Number:
716-369-9590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1694 ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALFMOON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12065-8816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-930-7486
Provider Business Practice Location Address Fax Number:
518-930-7487
Provider Enumeration Date:
08/16/2005

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: 207Q00000X , with the licence number:  009607 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 009607 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 5601007026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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