Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 170215-1 | NY |
NPI | 1023066065 |
---|---|
Provider Name | Dr. Matthew Antalek |
First Address | Williamsville, NY 14221-2700 |
Second Address | Williamsville, NY 14221-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01091923 | (05) | NY |
E37020 | (02) |