Provider Demographics
NPI:1639939689
Name:SAPANG, MARY ANGELA
Entity Type:Individual
Prefix:
First Name:MARY ANGELA
Middle Name:
Last Name:SAPANG
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 1:192 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1421
Mailing Address - Country:US
Mailing Address - Phone:201-680-8817
Mailing Address - Fax:
Practice Address - Street 1:631 GRAND ST STE 1-200
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3451
Practice Address - Country:US
Practice Address - Phone:201-435-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2805675363LA2200X
NJ26NJ14975600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health