Provider Demographics
NPI:1376961037
Name:ANTOINE, BERNADETTE L
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:L
Last Name:ANTOINE
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 1:55 LEBKAMP AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5509
Mailing Address - Country:US
Mailing Address - Phone:347-355-9488
Mailing Address - Fax:
Practice Address - Street 1:853 EMPIRE BLVD APT C5
Practice Address - Street 2:APT C5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5753
Practice Address - Country:US
Practice Address - Phone:347-355-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318000-1164W00000X
NY757295163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse