Provider Demographics
NPI:1215253513
Name:ARTHRITIS OF CORNWALL PLLC
Entity type:Organization
Organization Name:ARTHRITIS OF CORNWALL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOSHNAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-458-4868
Mailing Address - Street 1:21 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1469
Mailing Address - Country:US
Mailing Address - Phone:845-458-4868
Mailing Address - Fax:845-565-4801
Practice Address - Street 1:162 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6909
Practice Address - Country:US
Practice Address - Phone:347-249-9673
Practice Address - Fax:845-565-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty