Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X003309 | NY |
NPI | 1184994584 |
---|---|
Provider Name | Dr. Samuel Robert Anteby |
First Address | Brooklyn, NY 11230-6507 |
Second Address | Brooklyn, NY 11230-6507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2012 |
Last Update Date | 03/01/2012 |