Provider Demographics
NPI:1629410410
Name:ROBERTS, ANGELA MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:ZANGARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:462 FIRST AVE
Mailing Address - Street 2:ROOM 11N34
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-6343
Mailing Address - Fax:212-263-8743
Practice Address - Street 1:120 MINEOLA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4077
Practice Address - Country:US
Practice Address - Phone:516-663-3010
Practice Address - Fax:516-663-3026
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 337951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily