Provider Demographics
NPI:1487079158
Name:ANTEZANA, ELIZABETH (MS SP ED)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:ANTEZANA
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:LUYANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SP ED
Mailing Address - Street 1:5440 LITTLE NECK PKWY
Mailing Address - Street 2:APT 1T
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2200
Mailing Address - Country:US
Mailing Address - Phone:917-601-4071
Mailing Address - Fax:
Practice Address - Street 1:5440 LITTLE NECK PKWY
Practice Address - Street 2:APT 1T
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2200
Practice Address - Country:US
Practice Address - Phone:917-601-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist