Organization
189-04 FACILITY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN ANTONELLI M.D. (PRESIDENT)
(718) 217-1414
Entity
Organization
Contact information
Practice address
18904 UNION TPKE, SUITE B, FRESH MEADOWS, NY 11366-1862
(718) 271-1414
Mailing address
18904 UNION TPKE, SUITE B, FRESH MEADOWS, NY 11366-1862
(718) 271-1414
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
12/21/2014
Last updated
12/21/2014
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