Provider Demographics
NPI:1225876097
Name:ANTONIOS, TEREZA (OD)
Entity type:Individual
Prefix:DR
First Name:TEREZA
Middle Name:
Last Name:ANTONIOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FAWNHILL RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1539
Mailing Address - Country:US
Mailing Address - Phone:201-248-2702
Mailing Address - Fax:
Practice Address - Street 1:50 ROUTE 17K
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3918
Practice Address - Country:US
Practice Address - Phone:845-275-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist