Provider Demographics
NPI:1760628234
Name:ANTAKY, KARIN A (NP)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:A
Last Name:ANTAKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4235
Mailing Address - Country:US
Mailing Address - Phone:516-663-4525
Mailing Address - Fax:516-663-4532
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 370
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-663-4525
Practice Address - Fax:516-663-4532
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2014-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY333110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily