1760769152 NPI number — MRS. ANTAEYA NYREE FOSTER PA-C

Table of content: MRS. ANTAEYA NYREE FOSTER PA-C (NPI 1760769152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760769152 NPI number — MRS. ANTAEYA NYREE FOSTER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
ANTAEYA
Provider Middle Name:
NYREE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEAKE-GAYLORD
Provider Other First Name:
ANTAEYA
Provider Other Middle Name:
NYREE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760769152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 WILLIAMS STREET
Provider Second Line Business Mailing Address:
7TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-312-5400
Provider Business Mailing Address Fax Number:
845-354-7735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10970-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-664-0740
Provider Business Practice Location Address Fax Number:
845-354-7735
Provider Enumeration Date:
11/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  014459 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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