Healthcare Provider Details

I. General information

NPI: 1013080746
Provider Name (Legal Business Name): ALLEN ROBERT TANTLEFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 STARLING COURT
EAST HILLS NY
11576
US

IV. Provider business mailing address

57 STARLING COURT
EAST HILLS NY
11576
US

V. Phone/Fax

Practice location:
  • Phone: 516-626-3688
  • Fax: 516-626-3688
Mailing address:
  • Phone: 516-626-3688
  • Fax: 516-626-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1127221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: