Provider Demographics
NPI:1427334085
Name:ANTOKOLETZ, MARILYN GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:GAIL
Last Name:ANTOKOLETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARILYN
Other - Middle Name:ANTOKOLETZ
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:32 SHELTER ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3240
Mailing Address - Country:US
Mailing Address - Phone:516-365-9893
Mailing Address - Fax:
Practice Address - Street 1:32 SHELTER ROCK RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3240
Practice Address - Country:US
Practice Address - Phone:516-365-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics