Provider Demographics
NPI:1275309312
Name:ANTOH, PRISCILLA
Entity Type:Individual
Prefix:MISS
First Name:PRISCILLA
Middle Name:
Last Name:ANTOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 CONCOURSE VLG E APT 14L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3724
Mailing Address - Country:US
Mailing Address - Phone:347-964-9306
Mailing Address - Fax:
Practice Address - Street 1:830 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-5203
Practice Address - Country:US
Practice Address - Phone:718-542-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY790715-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool