Basic Information
| Provider Information | |||||||||
| NPI: | 1003909755 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GLASSCOCK | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 BROADWAY, DEPARTMENT OF PEDIATRICS 2B321 | ||||||||
| Address2: | WOODHULL MEDICAL & MENTAL HEALTH CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638214 | ||||||||
| FaxNumber: | 7186303122 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 NORTH PORTLAND AVENUE | ||||||||
| Address2: | CUMBERLAND DIAGNOSTIC & TREATMENT CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182607500 | ||||||||
| FaxNumber: | 7186303122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | F380947 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00246075 | 05 | NY | MEDICAID |