Provider Demographics
NPI:1164546537
Name:ANTELL, CRAIG (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:ANTELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:SUITE 1702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:212-757-1157
Mailing Address - Fax:212-757-7197
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 1702
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-757-1157
Practice Address - Fax:212-757-7197
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2094506208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2I0681Medicare PIN
NYG89237Medicare UPIN
NY2I0683Medicare PIN