Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 151853 | NY |
NPI | 1033144589 |
---|---|
Provider Name | Dr. Michel Antoine |
First Address | Spring Valley, NY 10977-4002 |
Second Address | Spring Valley, NY 10977-4002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 13/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01151711 | (05) | NY |