Organization
CONEY ISLAND MEDICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EWALD J ANTOINE MD (PRESIDENT)
(718) 758-5544
Entity
Organization
Contact information
Practice address
178 AVENUE S, BROOKLYN, NY 11223-2633
(718) 759-6707
(718) 758-5566
Mailing address
178 AVENUE S, BROOKLYN, NY 11223-2633
(718) 759-6707
(718) 759-6708
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01644706
—
NY
Enumeration date
08/09/2012
Last updated
12/12/2012
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