Provider Demographics
NPI:1295035491
Name:ANTZ, PHILIP HENRY
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:HENRY
Last Name:ANTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EMILY CT
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1817
Mailing Address - Country:US
Mailing Address - Phone:631-680-8850
Mailing Address - Fax:
Practice Address - Street 1:10 EMILY CT
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1817
Practice Address - Country:US
Practice Address - Phone:631-680-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081970104100000X
NY0811371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker