Individual
MELISSA ANTONOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
154 COMMACK RD STE 100, COMMACK, NY 11725-3457
(631) 499-8282
Mailing address
6141 69TH PL, MIDDLE VILLAGE, NY 11379-1126
(917) 922-7005
(917) 922-7005
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
631114
NY
363LP0200X
Pediatric Nurse Practitioner
F3822794-1
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
F382794
NY
Other
Enumeration date
04/04/2018
Last updated
07/14/2022
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