Provider Demographics
NPI:1427232545
Name:ATHANASIOS ANTONIADIS OB GYN PC
Entity Type:Organization
Organization Name:ATHANASIOS ANTONIADIS OB GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATHANASIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:OBGYN PC
Authorized Official - Phone:631-376-1010
Mailing Address - Street 1:750 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4411
Mailing Address - Country:US
Mailing Address - Phone:631-376-1010
Mailing Address - Fax:631-376-2156
Practice Address - Street 1:750 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4411
Practice Address - Country:US
Practice Address - Phone:631-376-1010
Practice Address - Fax:631-376-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW2L611Medicare PIN