Individual
ANGELICA IRENE SUPANSIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
160 BENNETT AVE, LIGHTHOUSE PEDIATRICS, NEW YORK, NY 10040-3803
(212) 781-0800
Mailing address
160 BENNETT AVE, LIGHTHOUSE PEDIATRICS, NEW YORK, NY 10040-3803
(212) 781-0800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
280787
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/10/2014
Last updated
07/28/2015
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