Provider Demographics
NPI:1801541479
Name:NTONOS, THRASYVOULOS (FNP)
Entity type:Individual
Prefix:
First Name:THRASYVOULOS
Middle Name:
Last Name:NTONOS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:AKIS
Other - Middle Name:
Other - Last Name:NTONOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:435 W 31ST ST APT 42P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 E 73RD ST APT GF
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3555
Practice Address - Country:US
Practice Address - Phone:917-436-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY349208OtherLICENSE NUMBER