Provider Demographics
NPI:1033305578
Name:MABASA, ANGELO C (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:C
Last Name:MABASA
Suffix:
Gender:M
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:153 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1718
Mailing Address - Country:US
Mailing Address - Phone:201-281-8840
Mailing Address - Fax:201-634-1615
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-530-7917
Practice Address - Fax:212-305-8304
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY305372-1363LA2200X
NJ26NJ00133000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health