Provider Demographics
NPI:1043491046
Name:GANGI-POLLACEK, DENISE CATHERINE (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:CATHERINE
Last Name:GANGI-POLLACEK
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:CATHERINE
Other - Last Name:GANGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3300
Practice Address - Fax:518-271-3440
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03155626Medicaid
NYJ400006744Medicare PIN