Provider Demographics
NPI:1083621502
Name:FLORES, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:FLORES
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 1:729 ROANOKE AVE
Mailing Address - Street 2:PO BOX 973
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2729
Mailing Address - Country:US
Mailing Address - Phone:631-727-1131
Mailing Address - Fax:631-727-6905
Practice Address - Street 1:729 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2729
Practice Address - Country:US
Practice Address - Phone:631-727-1131
Practice Address - Fax:631-727-6905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1174622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1743OtherVYTRA
NY00677349Medicaid
NY4416103OtherAETNA PPO
NY80141OtherHEALTHFIRST
NY0012458OtherAETNA HMO
NY1000015973OtherAFFINITY
NY0434140-006OtherCIGNA
NY493074OtherUNITED HEALTH COMMERCIAL
NYSF-0003363OtherSELECT PRO
NYAK00408OtherMDNY
NY80141OtherHEALTHFIRST
NY1000015973OtherAFFINITY