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Individual

DR. IVAN ANTONEVICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1729 BURRSTONE RD, NEW HARTFORD, NY 13413-1001
(315) 798-1567
(315) 798-1565
Mailing address
1729 BURRSTONE RD, NEW HARTFORD, NY 13413-1001
(315) 798-1567
(315) 798-1565

Taxonomy

Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
229252
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2729598-00
FL
Enumeration date
06/20/2006
Last updated
07/25/2016
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