Provider Demographics
NPI:1114223849
Name:ANTOINE, MYLES LUKE (SLP)
Entity Type:Individual
Prefix:MR
First Name:MYLES
Middle Name:LUKE
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GLENMORE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3101
Mailing Address - Country:US
Mailing Address - Phone:914-636-6326
Mailing Address - Fax:914-636-6326
Practice Address - Street 1:13 GLENMORE DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-3101
Practice Address - Country:US
Practice Address - Phone:914-636-6326
Practice Address - Fax:914-636-6326
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015645-1/7227468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist