Provider Demographics
NPI:1497240675
Name:LIBRANTI, ANGELA AMERICA (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:AMERICA
Last Name:LIBRANTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CENTRAL PARK S APT 107
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1449
Mailing Address - Country:US
Mailing Address - Phone:212-262-2500
Mailing Address - Fax:212-262-2500
Practice Address - Street 1:1455 WEST AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7304
Practice Address - Country:US
Practice Address - Phone:718-239-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022573-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05451529Medicaid