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General NPI Number Information
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NPI Number | 1205488103
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Entity Type | Individual
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Provider Name | ANTONIO CARLOS DA SILVA NP
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Gender | Male
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 530 1ST AVE STE 9V
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 212-263-7185
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Fax |
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Provider Business Mailing Address
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Address Line | 865 WILLOUGHBY AVE APT 6F
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City | BROOKLYN
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State | NY
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Zip | 11221-5980
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Country | US
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Telephone | 917-684-6724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 676972
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 676972
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License Number State | NY
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