Provider Demographics
NPI:1942203302
Name:KANTER, ALLAN (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:KANTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1316
Mailing Address - Country:US
Mailing Address - Phone:315-637-3368
Mailing Address - Fax:
Practice Address - Street 1:1101 ERIE BLVD E
Practice Address - Street 2:STE 100
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1144
Practice Address - Country:US
Practice Address - Phone:315-422-4412
Practice Address - Fax:315-422-4690
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00560729Medicaid
NY00560729Medicaid
NYB82882Medicare UPIN