Provider Demographics
NPI:1386745883
Name:ANTONIOS, VERA S (MD)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:S
Last Name:ANTONIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 REYNAL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3924
Mailing Address - Country:US
Mailing Address - Phone:917-945-9415
Mailing Address - Fax:
Practice Address - Street 1:123-125 WEST. 124TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4920
Practice Address - Country:US
Practice Address - Phone:212-531-1300
Practice Address - Fax:212-849-2786
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002533207RI0200X
NY259265207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02757133Medicaid
NY207SE34691OtherMEDICARE
NY207SE34691OtherMEDICARE