Provider Demographics
NPI:1871507707
Name:ANTONIADIS, EFSTARTIOS (PT)
Entity Type:Individual
Prefix:
First Name:EFSTARTIOS
Middle Name:
Last Name:ANTONIADIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3153
Mailing Address - Country:US
Mailing Address - Phone:718-821-4216
Mailing Address - Fax:718-821-4253
Practice Address - Street 1:6642 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3153
Practice Address - Country:US
Practice Address - Phone:718-821-4216
Practice Address - Fax:718-821-4253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01703Medicare PIN