Provider Demographics
NPI:1154365559
Name:ANTFLECK, ALAN MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARTIN
Last Name:ANTFLECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY237938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0904Medicare ID - Type Unspecified
NYG62237Medicare UPIN
NYIA0904Medicare PIN