Provider Demographics
NPI:1932529245
Name:IYARSAMI, ANTONIO NARINEDATT
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:NARINEDATT
Last Name:IYARSAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-845-3283
Practice Address - Street 1:2459 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5703
Practice Address - Country:US
Practice Address - Phone:516-826-2273
Practice Address - Fax:516-826-2272
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant