Individual
ELEANOR BANZON ANTOLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
206 E BROWN ST, EAST STROUDSBURG, PA 18301-3006
(570) 421-4000
(570) 424-3346
Mailing address
RR2 BOX 2440, CRESCO, PA 18326
(570) 420-8601
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD-061175-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017179400002
—
PA
05
—
017179400003
—
PA
Enumeration date
05/04/2007
Last updated
04/01/2024
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