Healthcare Provider Details

I. General information

NPI: 1134377260
Provider Name (Legal Business Name): ANGELA BOUDOUNIS-HATZIS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 NORTH HIGHLAND AVE SUITE 101
NYACK NY
10960
US

IV. Provider business mailing address

265 NORTH HIGHLAND AVE SUITE 101
NYACK NY
10960
US

V. Phone/Fax

Practice location:
  • Phone: 845-512-8434
  • Fax: 845-512-8435
Mailing address:
  • Phone: 845-512-8434
  • Fax: 845-512-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number051032
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: