MEDICARE: DR. ANTONIO E ALFONSO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	117277	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4466282	OTHER	NY	AETNA
2	0077128	OTHER	NY	GHI
3	644021	OTHER	NY	EMPIRE BC & BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	KS 359	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1598760670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO E ALFONSO M.D.

Provider Business Mailing Address
First Line	:	339 HICKS ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5509
Country	:	US
Telephone Number	:	718-875-3244
Fax Number	:	718-780-1037

Provider Business Practice Location Address
First Line	:	100 AMITY ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6005
Country	:	US
Telephone Number	:	718-875-3244
Fax Number	:	718-780-1037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/06/2010

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