Provider Demographics
NPI:1467826529
Name:ALAN ANTONELLI M.D. PC
Entity Type:Organization
Organization Name:ALAN ANTONELLI M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-217-1414
Mailing Address - Street 1:18904 UNION TPKE
Mailing Address - Street 2:QUEENS
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1862
Mailing Address - Country:US
Mailing Address - Phone:718-217-1414
Mailing Address - Fax:718-217-1669
Practice Address - Street 1:18904 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1862
Practice Address - Country:US
Practice Address - Phone:718-217-1414
Practice Address - Fax:718-217-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063565950OtherNPI
132116 NEW YORKOtherMEDICAL LICENSE
132116 NEW YORKOtherMEDICAL LICENSE
1063565950OtherNPI
132116 NEW YORKOtherMEDICAL LICENSE