J Andrew Fantl Gynecology PC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

1988811 Issued in NY

Legal business name

J ANDREW FANTL GYNECOLOGY PC

Practice address

222 Middle Country Rd
Suite 203
Smithtown, NY 11787

Phone

(631) 979-2842

Fax

(631) 979-2845

NPI assigned

Oct 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Andrew Fantl, MD

Title

Doctor President

Phone

(631) 979-2842

Specialties & licenses 1

Addresses

Other identifiers 8

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1679653448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 MIDDLE COUNTRY RD",
            "address_2": "SUITE 203",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "11787",
            "telephone_number": "631-979-2842",
            "fax_number": "631-979-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 MIDDLE COUNTRY RD",
            "address_2": "SUITE 203",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "11787",
            "telephone_number": "631-979-2842",
            "fax_number": "631-979-2845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J ANDREW FANTL GYNECOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "FANTL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "DOCTOR PRESIDENT",
        "authorized_official_telephone_number": "631-979-2842",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "1988811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "9658042",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5817720",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "665C41",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "198881",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "53073",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P1935301",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "P62326327",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDNY",
            "identifier": "AA50860",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gynecology Physician in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.