Provider Demographics
NPI:1801121561
Name:GLIATTA, ANGELA M
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:GLIATTA
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 1:30 BROAD ST
Mailing Address - Street 2:45TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2304
Mailing Address - Country:US
Mailing Address - Phone:212-530-0630
Mailing Address - Fax:212-867-4353
Practice Address - Street 1:30 BROAD ST
Practice Address - Street 2:45TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2304
Practice Address - Country:US
Practice Address - Phone:212-530-0630
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5133363A00000X
NY017370363A00000X
CA20601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant