Healthcare Provider Details

I. General information

NPI: 1720194152
Provider Name (Legal Business Name): KOSHNAF ANTAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MALTESE DR
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

111 MALTESE DR
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-4774
  • Fax: 845-818-7555
Mailing address:
  • Phone: 845-342-4774
  • Fax: 845-818-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number219104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: