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General NPI Number Information
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NPI Number | 1710202106
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Entity Type | Individual
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Provider Name | JOSEPH D'ANTONIO JR. RPH
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Gender | Male
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 699 GLEN COVE AVE
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City | GLEN HEAD
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State | NY
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Zip | 11545-1602
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Country | US
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Telephone | 516-676-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 34 JOHNSTON ST
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City | LOCUST VALLEY
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State | NY
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Zip | 11560-1219
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Country | US
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Telephone | 516-676-0131
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 031210-1
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License Number State | NY
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