Provider Demographics
NPI:1528286440
Name:ANTONIO, JOSEFINA S (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:S
Last Name:ANTONIO
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 1:1150 PORTION RD STE 18
Mailing Address - Street 2:P.O. BOX 392
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1074
Mailing Address - Country:US
Mailing Address - Phone:631-732-2320
Mailing Address - Fax:
Practice Address - Street 1:1150 PORTION RD STE 18
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1074
Practice Address - Country:US
Practice Address - Phone:631-732-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2284542084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry