Healthcare Provider Details

I. General information

NPI: 1851572655
Provider Name (Legal Business Name): CLAIRE JOAN ANTOSZEWSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 1/2 AMADO ST
SANTA FE NM
87501-3700
US

IV. Provider business mailing address

453 1/2 AMADO ST
SANTA FE NM
87501-3700
US

V. Phone/Fax

Practice location:
  • Phone: 203-249-3002
  • Fax:
Mailing address:
  • Phone: 203-249-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012262-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2010-0040
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: