Provider Demographics
NPI:1720255722
Name:BOWMAN, ANGELA J (MHS, CASAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MHS, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E MARKET ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2055
Mailing Address - Country:US
Mailing Address - Phone:845-309-4530
Mailing Address - Fax:
Practice Address - Street 1:107 E MARKET ST APT 1A
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2055
Practice Address - Country:US
Practice Address - Phone:845-309-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02740141Medicaid