Provider Demographics
NPI:1184682262
Name:ANTO, HEINO R (MD)
Entity Type:Individual
Prefix:DR
First Name:HEINO
Middle Name:R
Last Name:ANTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5115 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1042
Mailing Address - Country:US
Mailing Address - Phone:718-734-2870
Mailing Address - Fax:718-734-2247
Practice Address - Street 1:5115 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1042
Practice Address - Country:US
Practice Address - Phone:718-734-2870
Practice Address - Fax:718-734-2247
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123006207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314829Medicaid
NYB88124Medicare UPIN
NY14092Medicare PIN