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General NPI Number Information
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NPI Number | 1073505285
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Entity Type | Individual
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Provider Name | ANGELINA M MISENO-CALLAGHAN RPA-C
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 1694 ROUTE 9
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City | HALFMOON
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State | NY
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Zip | 12065-8816
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Country | US
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Telephone | 518-930-7486
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Fax | 518-930-7487
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | ELLICOTTVILLE
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State | NY
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Zip | 14731-0500
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Country | US
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Telephone | 716-699-9032
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Fax | 716-369-9590
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 009607
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 009607
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601007026
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License Number State | MI
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