Provider Demographics
NPI:1174706592
Name:DAVID J. ANTELL, D.O, PC
Entity type:Organization
Organization Name:DAVID J. ANTELL, D.O, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-673-0788
Mailing Address - Street 1:329 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2844
Mailing Address - Country:US
Mailing Address - Phone:212-673-0788
Mailing Address - Fax:212-533-8623
Practice Address - Street 1:329 E 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2844
Practice Address - Country:US
Practice Address - Phone:212-673-0788
Practice Address - Fax:212-533-8623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG67048Medicare UPIN