Healthcare Provider Details

I. General information

NPI: 1144304700
Provider Name (Legal Business Name): ANTONIO ALFREDO SAAVEDRA II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE
BRONX NY
10452-8001
US

IV. Provider business mailing address

9060 PALISADE AVE APT #402
NORTH BERGEN NJ
07047-6137
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2875
  • Fax: 718-960-2877
Mailing address:
  • Phone: 718-960-2867
  • Fax: 718-960-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number152350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: