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Anton Fetisov
NPI 1811698665 · on the registry since 2023 · sole proprietor
Practice
- Address
- 31 Kingston Ave
South Floral Park, NY 11001 - Phone
- (929) 928-0468
Registry record
- Primary taxonomy
- 163W00000X
163W00000X
- Also registered as
- 225700000X
- Licence states on file
- NY
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-06-09
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York