Provider Demographics
NPI:1760769152
Name:FOSTER, ANTAEYA NYREE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANTAEYA
Middle Name:NYREE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANTAEYA
Other - Middle Name:NYREE
Other - Last Name:LEAKE-GAYLORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:170 WILLIAMS STREET
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-312-5400
Mailing Address - Fax:845-354-7735
Practice Address - Street 1:31 HALLEY DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2001
Practice Address - Country:US
Practice Address - Phone:845-664-0740
Practice Address - Fax:845-354-7735
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014459363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical