Healthcare Provider Details

I. General information

NPI: 1235143595
Provider Name (Legal Business Name): ROBERT ANTAR MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 AVENUE R
BROOKLYN NY
11229-2803
US

IV. Provider business mailing address

269 W 10TH ST
NEW YORK NY
10014-2554
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-2111
  • Fax: 718-336-9472
Mailing address:
  • Phone: 212-243-4574
  • Fax: 212-352-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number118662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: