Provider Demographics
NPI:1750548269
Name:ANTOINE-GUSTAVE, VALERIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:ANTOINE-GUSTAVE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 5TH AVE
Mailing Address - Street 2:SUITE 611
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3620
Mailing Address - Country:US
Mailing Address - Phone:212-227-3688
Mailing Address - Fax:212-227-3368
Practice Address - Street 1:525 E 68TH ST # M-528
Practice Address - Street 2:BOX 130
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-4749
Practice Address - Fax:212-746-6692
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY257450207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty