Individual
ANTON FETISOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
31 KINGSTON AVE, SOUTH FLORAL PARK, NY 11001-3517
(929) 928-0468
Mailing address
31 KINGSTON AVE, SOUTH FLORAL PARK, NY 11001-3517
(929) 928-0468
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
978345
NY
225700000X
Massage Therapist
033053
NY
Other
Enumeration date
03/16/2023
Last updated
06/09/2025
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