Provider Demographics
NPI:1770731325
Name:ANTONIOS VLANTIS
Entity type:Organization
Organization Name:ANTONIOS VLANTIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIOS
Authorized Official - Middle Name:L
Authorized Official - Last Name:VLANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-267-0510
Mailing Address - Street 1:170-03 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-267-0510
Mailing Address - Fax:
Practice Address - Street 1:170-03 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-267-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00993540Medicaid
NYA64552Medicare UPIN