Basic Information
| Provider Information | |||||||||
| NPI: | 1649248741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGOFF | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 367 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037372169 | ||||||||
| FaxNumber: | 2037375495 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 YORK ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036885303 | ||||||||
| FaxNumber: | 2036883216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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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 | 207R00000X | 033035 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001330357 | 05 | CT | MEDICAID |