Provider Demographics
NPI:1114460722
Name:AGRUSA, ANGELA MARIA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:AGRUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIA
Other - Last Name:FALZONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17410 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2031
Mailing Address - Country:US
Mailing Address - Phone:718-358-2243
Mailing Address - Fax:718-358-2989
Practice Address - Street 1:17410 67TH AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2031
Practice Address - Country:US
Practice Address - Phone:718-358-2243
Practice Address - Fax:718-358-2989
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021154-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist