Evgeny Antonov

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

312910 Issued in NY

Practice address

56 Foster Rd
Staten Island, NY 10309-3011

Phone

(718) 605-6767

NPI assigned

Apr 20, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1376930156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 FOSTER RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103093011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 FOSTER RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103093011",
            "telephone_number": "718-605-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONOV",
        "first_name": "EVGENY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-20",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "686164",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "312910",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11048524",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allysia Antoine
• Wayne Antoine, LMSW
• Antoinette Cavalenes Joyce
• Melissa Elizabeth Antonelli
• Ingrid Antonios, MD
• Kirill Antonov, MD
• Olga Antonova
• Yulia Antonova
• Anju Antony, OTR/L
• Chelsea Antwi

• Adult Health Nurse Practitioner in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.