Provider Demographics
NPI:1033144589
Name:ANTOINE, MICHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4002
Mailing Address - Country:US
Mailing Address - Phone:845-356-3500
Mailing Address - Fax:845-356-9190
Practice Address - Street 1:251 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4002
Practice Address - Country:US
Practice Address - Phone:845-356-3500
Practice Address - Fax:845-356-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151853207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01151711Medicaid
NY01151711Medicaid