1881888584 NPI number — CRAIG ANTELL, D.O.,P.C.

Table of content: DR. VICTORIA ALEXANDROVNA WILSON PH.D. (NPI 1245597772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881888584 NPI number — CRAIG ANTELL, D.O.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG ANTELL, D.O.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881888584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
274 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-0701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-685-1666
Provider Business Mailing Address Fax Number:
212-685-8612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
274 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-0701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-685-1666
Provider Business Practice Location Address Fax Number:
212-685-8612
Provider Enumeration Date:
09/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARCUS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
212-685-1666

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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