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Individual

DR. THEODORE ANTONETZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
185 WEST END AVENUE, SUITE 1N, NYC, NY 10023
(212) 877-3062
(212) 873-9521
Mailing address
185 WEST END AVENUE, SUITE 1N, NYC, NY 10023
(212) 877-3062

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N004056
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P43851
BLUE CROSS/BLUE SHIELD
NY
Enumeration date
09/25/2006
Last updated
08/06/2010
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