Healthcare Provider Details

I. General information

NPI: 1407870165
Provider Name (Legal Business Name): ANGELA AMADA CROSDALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 MAIN ST
FISHKILL NY
12524-1789
US

IV. Provider business mailing address

969 MAIN ST
FISHKILL NY
12524-1789
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-8233
  • Fax: 845-896-3039
Mailing address:
  • Phone: 845-896-8233
  • Fax: 845-896-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number141158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: