Provider Demographics
NPI:1366791998
Name:ALAN M ANTFLECK PHYSICIAN PLLC
Entity type:Organization
Organization Name:ALAN M ANTFLECK PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:ANTFLECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-551-1970
Mailing Address - Street 1:3800 DELAWARE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1094
Mailing Address - Country:US
Mailing Address - Phone:716-551-1970
Mailing Address - Fax:716-783-8557
Practice Address - Street 1:3800 DELAWARE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1094
Practice Address - Country:US
Practice Address - Phone:716-551-1970
Practice Address - Fax:716-783-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty