Provider Demographics
NPI:1417912809
Name:ATOYNATAN, IOANIS (MD)
Entity Type:Individual
Prefix:
First Name:IOANIS
Middle Name:
Last Name:ATOYNATAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3513
Mailing Address - Country:US
Mailing Address - Phone:718-688-8000
Mailing Address - Fax:718-385-5104
Practice Address - Street 1:5205 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3513
Practice Address - Country:US
Practice Address - Phone:718-688-8000
Practice Address - Fax:718-385-5104
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01811930Medicaid
NY01811930Medicaid
NYB43826Medicare UPIN