Provider Demographics
NPI:1356414122
Name:ANGLADE, ALBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:ANGLADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALBERT
Other - Middle Name:A
Other - Last Name:ANGLADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1711 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3319
Mailing Address - Country:US
Mailing Address - Phone:718-703-4968
Mailing Address - Fax:718-703-6720
Practice Address - Street 1:1711 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3319
Practice Address - Country:US
Practice Address - Phone:718-703-4968
Practice Address - Fax:718-703-6720
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01883027Medicaid
NYG82049Medicare UPIN
NY45C601Medicare ID - Type Unspecified