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NPI Code Detail

MEDICARE: MS. ANGELA R TASSA LPN

MEDICARE: MS. ANGELA R TASSA LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse306789-1NY

General Provider Information

NPI Number : 1801170790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA R TASSA LPN
Provider Business Mailing Address
First Line : 80 MARILYNN ST
Second Line :
City : EAST ISLIP
State : NY
Zip : 11730-2705
Country : US
Telephone Number : 631-581-0465
Fax Number :
Provider Business Practice Location Address
First Line : 74 MILL DR
Second Line :
City : MASTIC BEACH
State : NY
Zip : 11951-1403
Country : US
Telephone Number : 631-657-6038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2011
Last Update Date : 10/11/2011

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