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NPI Code Detail

MEDICARE: MICHELLE ANTONOWICZ M.D.

MEDICARE: MICHELLE ANTONOWICZ M.D.
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
1207P00000XEmergency Medicine Physician25MA07150800NJ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1045292OTHERNJMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780683128
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE ANTONOWICZ M.D.
Provider Business Mailing Address
First Line : 28 SUNSET DR
Second Line :
City : NORTH CALDWELL
State : NJ
Zip : 07006-4750
Country : US
Telephone Number : 973-396-8490
Fax Number :
Provider Business Practice Location Address
First Line : 1 BAY AVE
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07042-4837
Country : US
Telephone Number : 973-429-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 05/18/2008

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Directions to “ MICHELLE ANTONOWICZ M.D.” Practice Location

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