Healthcare Provider Details

I. General information

NPI: 1164095253
Provider Name (Legal Business Name): ANTIDOTE A.I. HEALTH OF FL P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 BROADWAY
NEW YORK NY
10036-7329
US

IV. Provider business mailing address

1460 BROADWAY
NEW YORK NY
10036-7329
US

V. Phone/Fax

Practice location:
  • Phone: 845-213-3504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BARUCH BERZON
Title or Position: OWNER
Credential:
Phone: 845-213-3504