Provider Demographics
NPI:1952578692
Name:TY SEMAR, ANTONIA (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:
Last Name:TY SEMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTONIA
Other - Middle Name:
Other - Last Name:TY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:342 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1144
Mailing Address - Country:US
Mailing Address - Phone:201-569-0410
Mailing Address - Fax:201-569-9597
Practice Address - Street 1:342 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1144
Practice Address - Country:US
Practice Address - Phone:201-569-0410
Practice Address - Fax:201-569-9597
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02531300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics