Provider Demographics
NPI:1982662284
Name:SWEENY, ANGELA H (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:H
Last Name:SWEENY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-9158
Mailing Address - Fax:718-226-6964
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-9158
Practice Address - Fax:718-226-6964
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219989207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1982662284OtherTUFTS
NH1982662284OtherANTHEM BCBS
NY03505066Medicaid
MA110039967AMedicaid
MAJ29625OtherBS
MA2091721Medicaid
NH30209862Medicaid
MA447527OtherTUFTS
NH1982662284OtherMULTIPLAN
NH1982662284OtherTUFTS
MAJ29625OtherBS
NYA400077283Medicare PIN
NH001826801Medicare PIN