Angelica Irene Supansic, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

280787 Issued in NY

Practice address

160 Bennett Ave
Lighthouse Pediatrics
New York, NY 10040-3803

Phone

(212) 781-0800

NPI assigned

Sep 10, 2014

Last updated

Jul 28, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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

• Lighthouse Pediatrics, PC

  • Pediatrics Physician
  • New York, NY
  • NPI 1750509022
  NPD (past)
• Women Midwifery Health Care Service PC

  • Advanced Practice Midwife
  • New York, NY
  • NPI 1578883120
  NPD (past)

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

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438041600000",
    "number": "1477954378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 BENNETT AVE",
            "address_2": "LIGHTHOUSE PEDIATRICS",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100403803",
            "telephone_number": "212-781-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 BENNETT AVE",
            "address_2": "LIGHTHOUSE PEDIATRICS",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100403803",
            "telephone_number": "212-781-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPANSIC",
        "first_name": "ANGELICA",
        "middle_name": "IRENE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-10",
        "last_updated": "2015-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "280787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael John Sunyak, MD
• Dana Marie Suozzi, PSY.D.
• William Gregory Suozzi, MD
• Christianne Supan
• Gliceria Supan
• Susan Super, MA, ED.
• Superdent Dentistry PLLC (Sutton Place Dental Associates)
• Superior Medical Group & Partners Inc
• Superior Member Coordinators Corporation
• Superior Vision of New York, Inc.

• Pediatrics Physician in New York, NY
• Providers in New York, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.