=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801121561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA M GLIATTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2009
-----------------------------------------------------
Last Update Date | 01/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 BROAD ST 45TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-530-0630
-----------------------------------------------------
Fax | 212-867-4353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 BROAD ST 45TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-530-0630
-----------------------------------------------------
Fax | 212-867-4353
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA5133
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 017370
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 20601
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------