Provider Demographics
NPI:1194090365
Name:ANTON, PETRI
Entity type:Individual
Prefix:
First Name:PETRI
Middle Name:
Last Name:ANTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ROEBLING ST
Mailing Address - Street 2:APARTMENT 5E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2262
Mailing Address - Country:US
Mailing Address - Phone:917-545-5357
Mailing Address - Fax:
Practice Address - Street 1:63 ROEBLING ST
Practice Address - Street 2:APARTMENT 5E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2262
Practice Address - Country:US
Practice Address - Phone:917-545-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004458-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist