Provider Demographics
NPI:1477677342
Name:ANTONOPOULOS, MARIA R (LIC ACUP)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:R
Last Name:ANTONOPOULOS
Suffix:
Gender:F
Credentials:LIC ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 ROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1042
Mailing Address - Country:US
Mailing Address - Phone:516-395-0966
Mailing Address - Fax:
Practice Address - Street 1:538 WESTBURY AVE
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1747
Practice Address - Country:US
Practice Address - Phone:516-395-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0025361171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist