Individual
ATHANASIOS ANTONIADIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
750 MONTAUK HWY, WEST ISLIP, NY 11795-4411
(631) 376-1010
(631) 376-6156
Mailing address
750 MONTAUK HWY, WEST ISLIP, NY 11795-4411
(631) 376-1010
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
1831001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37K392
BLUE CROSS
NY
01
—
P790338
OXFORD
NY
Enumeration date
09/17/2006
Last updated
04/09/2014
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