Provider Demographics
NPI:1073151601
Name:ANTOINE, OLIVER ASNE I (MASSAGE THERAPY)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:ASNE
Last Name:ANTOINE
Suffix:I
Gender:M
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:OLIVER
Other - Middle Name:ASNE
Other - Last Name:ANTOINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPY
Mailing Address - Street 1:1848 FLATBUSH AVE # K1848
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4831
Mailing Address - Country:US
Mailing Address - Phone:917-808-8002
Mailing Address - Fax:
Practice Address - Street 1:1848 FLATBUSH AVE # K1848
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4831
Practice Address - Country:US
Practice Address - Phone:917-808-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01030600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist