Individual provider Active NPI

Angela Memmelaar, NP

  • Adult Health Nurse Practitioner
  • Schenectady, NY
National Provider Identifier
1336496025
Registry record updated Jan 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
306051 Issued in NY
Practice address
2125 River Rd
Suite 303
Schenectady, NY 12309-1135
Phone
(518) 382-8350
Fax
(518) 382-0345
NPI assigned
Aug 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 306051 NY Primary

Addresses

Primary practice location

2125 River Rd
Suite 303
Schenectady, NY 12309-1135

Mailing address

711 Troy Schenectady Rd Ste 203
Latham, NY 12110-2461
Phone (518) 782-3700

Other identifiers 2

IdentifierTypeStateIssuer
03494497MedicaidNY
121109000005OtherNYFIDELIS CARE NY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121008000548 NY Practitioner - Nurse Practitioner 4981853983 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Glens Falls Hospital IncGroup PAC ID 8325955974, 175 clinicians

Practice addresses (Care Compare)

102 Park St
Glens Falls, NY 12801-4403
Phone (518) 926-2940

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital CurrentSince Jul 26, 2020 Accepting new patients
Glens Falls Hospital Inc. CurrentSince Jul 10, 2025 Accepting new patients
Saratoga Hospital Current Accepting new patients
Glens Falls Hospital Inc CurrentSince Jul 10, 2025 Accepting new patients
Saratoga Hospital CurrentSince Jul 26, 2020 Accepting new patients

Locations

102 Park St
Glens Falls, NY 12801
Phone (518) 793-5601

100 Park St
Glens Falls, NY 12801
Phone (518) 926-5924

79 North St
Granville, NY 12832
Phone (518) 642-0612

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

1 West Ave
Ste 300
Saratoga Springs, NY 12866
Phone (518) 693-4699

Interoperability endpoints

  • Direct secure messaging: amemmelaar141800@albanymed.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1336496025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 RIVER RD",
            "address_2": "SUITE 303",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123091135",
            "telephone_number": "518-382-8350",
            "fax_number": "518-382-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMMELAAR",
        "first_name": "ANGELA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "306051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03494497",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS CARE NY",
            "identifier": "121109000005",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.