Provider Demographics
NPI:1245501006
Name:FIGUEROA, ANTONIO JOSE
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JOSE
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FOREST DR APT A
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-2141
Mailing Address - Country:US
Mailing Address - Phone:845-709-2900
Mailing Address - Fax:
Practice Address - Street 1:12 FOREST DR APT A
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-2141
Practice Address - Country:US
Practice Address - Phone:845-709-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008082-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program