Provider Demographics
NPI:1598086902
Name:LIONEL A. SIFONTES, M.D, P.C.
Entity Type:Organization
Organization Name:LIONEL A. SIFONTES, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SIFONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-837-2772
Mailing Address - Street 1:2772 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1704
Mailing Address - Country:US
Mailing Address - Phone:716-837-2772
Mailing Address - Fax:716-837-0041
Practice Address - Street 1:2772 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1704
Practice Address - Country:US
Practice Address - Phone:716-837-2772
Practice Address - Fax:716-837-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB35901Medicare UPIN
NY040891Medicare PIN
NY00615476Medicare PIN