Provider Demographics
NPI:1801371653
Name:ANTONY, REENA ROSE
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:ROSE
Last Name:ANTONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 ERIC LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3602
Mailing Address - Country:US
Mailing Address - Phone:845-642-7502
Mailing Address - Fax:718-441-6058
Practice Address - Street 1:10913 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2335
Practice Address - Country:US
Practice Address - Phone:718-441-6048
Practice Address - Fax:718-441-6058
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342705-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily