Provider Demographics
NPI:1609882588
Name:ANTOINE, ALYCIA NATASHA (MD)
Entity type:Individual
Prefix:DR
First Name:ALYCIA
Middle Name:NATASHA
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:62 GREENDALE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3406
Mailing Address - Country:US
Mailing Address - Phone:973-777-9973
Mailing Address - Fax:
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5526
Practice Address - Country:US
Practice Address - Phone:201-435-3055
Practice Address - Fax:201-435-3198
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07948600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine