Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Anton Fetisov

Individual provider Massage Therapist · NPI 1811698665

Anton Fetisov is a Massage Therapist in South Floral Park, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2023
Specialties on file
2

Practice location Address checks out

31 Kingston Ave
South Floral Park, NY 11001-3517
Phone: (929) 928-0468
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 978345 (NY)
Massage Therapist Taxonomy 225700000X · Licence 033053 (NY)

Record details

NPI number1811698665
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 16, 2023
Last updated in NPPESJune 9, 2025
Certification dateJune 9, 2025