Individual
DR. MICHAEL ANTONELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 WILDFLOWER LN, EAST HAMPTON, NY 11937-4311
(631) 329-8414
Mailing address
2 WILDFLOWER LN, EAST HAMPTON, NY 11937-4311
(631) 329-8414
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
090464
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090464
NY STATE
NY
01
—
NONE
NONE
—
Enumeration date
09/28/2017
Last updated
09/28/2017
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