Provider Demographics
NPI:1457416422
Name:AGREGADO, ANGELINE M (MD)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:M
Last Name:AGREGADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 66TH ST
Mailing Address - Street 2:APT. 2H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6227
Mailing Address - Country:US
Mailing Address - Phone:718-920-2273
Mailing Address - Fax:718-652-5715
Practice Address - Street 1:MMC - FAMILY CARE CENTER
Practice Address - Street 2:3444 KOSSUTH AVE. 1ST FL. RM B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics