Healthcare Provider Details

I. General information

NPI: 1831231109
Provider Name (Legal Business Name): ANGELA SIMIONE ALBINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA SIMIONE-ALBINO PA

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE PA OFFICE
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

104 UNION AVE SUITE 804
SYRACUSE NY
13203-1843
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5111
  • Fax: 315-703-5049
Mailing address:
  • Phone: 315-703-5049
  • Fax: 315-703-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011653
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11653-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: