Provider Demographics
NPI:1649450263
Name:BAILEY, ANGELA ELIZABETH
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELIZABETH
Last Name:BAILEY
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 1:408 HAWTHORNE AVE
Mailing Address - Street 2:3RD FL
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2817
Mailing Address - Country:US
Mailing Address - Phone:914-376-2932
Mailing Address - Fax:
Practice Address - Street 1:408 HAWTHORNE AVE
Practice Address - Street 2:3RD FL
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2817
Practice Address - Country:US
Practice Address - Phone:914-376-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288540164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02909942Medicaid