=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962812529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA TERESA ANTON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2014
-----------------------------------------------------
Last Update Date | 02/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9965 64TH RD APT 5F
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-564-5813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11233 SW 72ND AVE
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-4609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-564-5813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 288307
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------