Healthcare Provider Details

I. General information

NPI: 1720130867
Provider Name (Legal Business Name): L. PAUL ANTOINE SANON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CENTRAL PARK W STE 1K
NEW YORK NY
10024-6020
US

IV. Provider business mailing address

86-15 MARENGO STREET
HOLLISWOOD NY
11423-1325
US

V. Phone/Fax

Practice location:
  • Phone: 212-362-4818
  • Fax: 718-776-8055
Mailing address:
  • Phone: 718-468-8248
  • Fax: 718-776-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number196131
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number196131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: