Provider Demographics
NPI:1174999320
Name:BLAIR-ADAMS, ANGELA (OASAS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BLAIR-ADAMS
Suffix:
Gender:F
Credentials:OASAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10638 150TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5154
Mailing Address - Country:US
Mailing Address - Phone:718-291-6400
Mailing Address - Fax:
Practice Address - Street 1:10638 150TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5154
Practice Address - Country:US
Practice Address - Phone:718-291-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25881171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator