Provider Demographics
NPI:1073185823
Name:ANTOINE, MCFREDY
Entity Type:Individual
Prefix:
First Name:MCFREDY
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LEFFERTS AVE APT 5D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3909
Mailing Address - Country:US
Mailing Address - Phone:347-512-7405
Mailing Address - Fax:718-679-9361
Practice Address - Street 1:100 LEFFERTS AVE APT 5D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3909
Practice Address - Country:US
Practice Address - Phone:347-512-7405
Practice Address - Fax:718-679-9361
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1143721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist