Individual
EVGENY ANTONOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
56 FOSTER RD, STATEN ISLAND, NY 10309-3011
(718) 605-6767
Mailing address
56 FOSTER RD, STATEN ISLAND, NY 10309-3011
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
686164
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11048524
FL
Other
Enumeration date
04/20/2015
Last updated
06/17/2026
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