Provider Demographics
NPI:1023066065
Name:ANTALEK, MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:ANTALEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 MAPLE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2700
Mailing Address - Country:US
Mailing Address - Phone:716-204-5933
Mailing Address - Fax:716-204-5934
Practice Address - Street 1:1829 MAPLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2700
Practice Address - Country:US
Practice Address - Phone:716-204-5933
Practice Address - Fax:716-204-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170215-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01091923Medicaid
E37020Medicare UPIN
282303Medicare ID - Type Unspecified