Individual provider · Type 1 NPI
Evgeny Antonov
Adult Health Nurse Practitioner · Staten Island, NY
NPI number
1376930156
Active
Practice location
56 Foster Rd
Staten Island, NY 10309-3011
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 686164 (NY) |
| Adult Health Nurse Practitioner Primary | 363LA2200X | 312910 (NY) |
| Adult Health Nurse Practitioner | 363LA2200X | APRN11048524 (FL) |
Adult Health Nurse Practitioner: Definition to come...
Another provider at this address
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About NPI 1376930156
Evgeny Antonov's National Provider Identifier is 1376930156, issued on Apr 20, 2015. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Staten Island, NY. The record was last updated on Jul 22, 2026.