Provider Demographics
NPI:1003909755
Name:GLASSCOCK, ANGELA (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GLASSCOCK
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY, DEPARTMENT OF PEDIATRICS 2B321
Mailing Address - Street 2:WOODHULL MEDICAL & MENTAL HEALTH CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-963-8214
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:100 NORTH PORTLAND AVENUE
Practice Address - Street 2:CUMBERLAND DIAGNOSTIC & TREATMENT CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-260-7500
Practice Address - Fax:718-630-3122
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF380947363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid