MEDICARE: DR. ROBERT ANTAR MD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	118662	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235143595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ANTAR MD.

Provider Business Mailing Address
First Line	:	269 W 10TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-2554
Country	:	US
Telephone Number	:	212-243-4574
Fax Number	:	212-352-0673

Provider Business Practice Location Address
First Line	:	1319 AVENUE R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2803
Country	:	US
Telephone Number	:	718-339-2111
Fax Number	:	718-336-9472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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