1447309125 NPI number — DR. JON ALAN MUNTZ M.D.

Table of content: KELLIE BONSOR APRN, FNP-BC (NPI 1861086050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447309125 NPI number — DR. JON ALAN MUNTZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNTZ
Provider First Name:
JON
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447309125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N MAPLEMERE RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-3178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-836-4646
Provider Business Mailing Address Fax Number:
716-672-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N MAPLEMERE RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-3178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-836-4646
Provider Business Practice Location Address Fax Number:
716-672-8060
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  085798 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000511785004 . This is a "BC FOR N. CHAUT RADIOL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CM1926 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01246304 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161435431 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000267043002 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000511785003 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026704301 . This is a "UNIV FOR N. CHAUT RAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5609140 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 114537600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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