Provider Demographics
NPI:1689230369
Name:ANTIARIS, GINA (DVM)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:ANTIARIS
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MILLER CLARK ANIMAL HOSPITAL
Mailing Address - Street 2:1621 HARRISON AVE
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543
Mailing Address - Country:US
Mailing Address - Phone:914-698-1756
Mailing Address - Fax:
Practice Address - Street 1:MILLER CLARK ANIMAL HOSPITAL
Practice Address - Street 2:1621 HARRISON AVE
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-698-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9476OtherWE DO NOT TAKE INSURANCE