MEDICARE: VLADIMIR ANTONIAK

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	183500000X	Pharmacist	I07093001	NY

General Provider Information

NPI Number	:	1740062827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VLADIMIR ANTONIAK

Provider Business Mailing Address
First Line	:	60 CANTON CT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-6377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1404
Country	:	US
Telephone Number	:	718-284-4221
Fax Number	:

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	03/07/2024

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Directions to “ VLADIMIR ANTONIAK ” Practice Location

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