Provider Demographics
NPI:1255533311
Name:EYSSALLENNE, ANTONIA P (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:P
Last Name:EYSSALLENNE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 SAINT JOSEPH PL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2023
Mailing Address - Country:US
Mailing Address - Phone:305-298-8156
Mailing Address - Fax:
Practice Address - Street 1:14015 SANFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2688
Practice Address - Country:US
Practice Address - Phone:718-450-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine