Healthcare Provider Details

I. General information

NPI: 1093176430
Provider Name (Legal Business Name): ANGLADE DUBUISSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2016
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOBART CT
NEW CITY NY
10956-1913
US

IV. Provider business mailing address

1 HOBART CT
NEW CITY NY
10956-1913
US

V. Phone/Fax

Practice location:
  • Phone: 845-671-0337
  • Fax:
Mailing address:
  • Phone: 845-671-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number710673
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: