Provider Demographics
NPI:1831814144
Name:ANTONY, MINI ROY
Entity type:Individual
Prefix:MRS
First Name:MINI
Middle Name:ROY
Last Name:ANTONY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MINI
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 CIDER MILL CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2709
Mailing Address - Country:US
Mailing Address - Phone:845-642-5401
Mailing Address - Fax:
Practice Address - Street 1:8 CIDER MILL CT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2709
Practice Address - Country:US
Practice Address - Phone:845-642-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349972-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine