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NPI Code Detail

MEDICARE: MINIMOL ANTONY

MEDICARE: MINIMOL ANTONY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician301356NY
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1417499310
Entity Type Code : Individual
Provider Name (Legal Business Name) : MINIMOL ANTONY
Provider Business Mailing Address
First Line : 2107 DITMAS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-6903
Country : US
Telephone Number : 718-262-8100
Fax Number : 929-264-5950
Provider Business Practice Location Address
First Line : 2107 DITMAS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-6903
Country : US
Telephone Number : 718-226-8100
Fax Number : 929-264-5950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2016
Last Update Date : 07/28/2022

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Directions to “ MINIMOL ANTONY ” Practice Location

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