Antonevich, Ivan

Antonevich, Ivan is an individual health care provider with primary practice located at 1729 Burrstone Rd , New Hartford NY 13413-1001. He recently has only one registered license in Allopathic & Osteopathic Physicians / Interventional Pain Medicine, which is considered as his primary health care specialty. Antonevich, Ivan can be contacted via phone (315) 798-1567.

Contact Information

Primary practice address
1729 Burrstone Rd New Hartford NY 13413-1001
Phone: (315) 798-1567
Fax: (315) 798-1565
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 229252 New York

Profile Details

NPI number 1043256118
LBN Legal business name Antonevich, Ivan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2006
Last updated Jul 25th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043256118 NPPES
Florida MEDICAID 2729598-00

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