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General NPI Number Information
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NPI Number | 1255533311
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Entity Type | Individual
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Provider Name | ANTONIA P EYSSALLENNE MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 14015 SANFORD AVE STE B
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City | FLUSHING
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State | NY
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Zip | 11355-2688
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Country | US
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Telephone | 718-450-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 427 SAINT JOSEPH PL
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-2023
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Country | US
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Telephone | 305-298-8156
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 301300
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License Number State | NY
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