Provider Demographics
NPI:1750603015
Name:ANTOINE, RITHA MARLEY
Entity type:Individual
Prefix:MISS
First Name:RITHA
Middle Name:MARLEY
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 1:415 STRATFORD ROAD
Mailing Address - Street 2:APT 4K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:347-469-7296
Mailing Address - Fax:
Practice Address - Street 1:415 STRATFORD RD
Practice Address - Street 2:APT 4K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5345
Practice Address - Country:US
Practice Address - Phone:347-469-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297849164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse