Provider Demographics
NPI:1669531331
Name:ANTELL, DARRICK E (MD)
Entity type:Individual
Prefix:DR
First Name:DARRICK
Middle Name:E
Last Name:ANTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARSONAGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-3937
Mailing Address - Country:US
Mailing Address - Phone:203-869-7318
Mailing Address - Fax:
Practice Address - Street 1:850 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1857
Practice Address - Country:US
Practice Address - Phone:212-988-4040
Practice Address - Fax:212-988-0527
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A65074Medicare UPIN