Organization
J ANDREW FANTL GYNECOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ANDREW FANTL MD (DOCTOR PRESIDENT)
(631) 979-2842
Entity
Organization
Contact information
Practice address
222 MIDDLE COUNTRY RD, SUITE 203, SMITHTOWN, NY 11787
(631) 979-2842
(631) 979-2845
Mailing address
222 MIDDLE COUNTRY RD, SUITE 203, SMITHTOWN, NY 11787
(631) 979-2842
(631) 979-2845
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
1988811
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198881
HIP
—
01
—
53073
VYTRA
—
01
—
5817720
CIGNA
—
01
—
665C41
BCBS
—
01
—
9658042
GHI
—
01
—
AA50860
MDNY
—
01
—
P1935301
OXFORD
—
01
—
P62326327
MULTIPLAN
—
Enumeration date
10/16/2006
Last updated
05/13/2008
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