Provider Demographics
NPI:1326736893
Name:MASSARI, ANGELO MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:MICHAEL
Last Name:MASSARI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:ANGELO
Other - Middle Name:MICHAEL
Other - Last Name:MASSARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:6 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1959
Mailing Address - Country:US
Mailing Address - Phone:914-426-4636
Mailing Address - Fax:
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant