Healthcare Provider Details

I. General information

NPI: 1083154520
Provider Name (Legal Business Name): KAREN LISA ANTLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE FL 7
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6003
  • Fax:
Mailing address:
  • Phone: 212-305-6003
  • Fax: 212-305-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR16647200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number308655
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: