Provider Demographics
NPI:1578897468
Name:CASSADIME, ANGELA LY'NECE
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LY'NECE
Last Name:CASSADIME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 COLGATE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2202
Mailing Address - Country:US
Mailing Address - Phone:201-420-7236
Mailing Address - Fax:201-420-3672
Practice Address - Street 1:86 COLGATE ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2202
Practice Address - Country:US
Practice Address - Phone:201-420-7236
Practice Address - Fax:201-420-3672
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor