Healthcare Provider Details

I. General information

NPI: 1902827413
Provider Name (Legal Business Name): ROGER ANTOINE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 NOSTRAND AVE
BROOKLYN NY
11205-4924
US

IV. Provider business mailing address

55 WATER ST 12TH FLOOR
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-826-5900
  • Fax:
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number125715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: