Provider Demographics
NPI:1639277288
Name:DE LOS REYES, ANTONIETTA (FNP)
Entity Type:Individual
Prefix:MISS
First Name:ANTONIETTA
Middle Name:
Last Name:DE LOS REYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10752 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1507
Mailing Address - Country:US
Mailing Address - Phone:646-220-9055
Mailing Address - Fax:
Practice Address - Street 1:1361 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1902
Practice Address - Country:US
Practice Address - Phone:718-979-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334883363L00000X
NJ26NJ00169800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily