Provider Demographics
NPI:1851592927
Name:PANTELIAS, ANGELA V (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:V
Last Name:PANTELIAS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 FRIEDENSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:LONG EDDY
Mailing Address - State:NY
Mailing Address - Zip Code:12760-5906
Mailing Address - Country:US
Mailing Address - Phone:845-887-2060
Mailing Address - Fax:
Practice Address - Street 1:15211 89TH AVE
Practice Address - Street 2:2ND FLOOR ORTHOPAEDICS
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3730
Practice Address - Country:US
Practice Address - Phone:718-558-7240
Practice Address - Fax:718-558-6181
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0037321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0037321Medicare UPIN