Provider Demographics
NPI:1447309125
Name:MUNTZ, JON ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:ALAN
Last Name:MUNTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 N MAPLEMERE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3178
Mailing Address - Country:US
Mailing Address - Phone:716-836-4646
Mailing Address - Fax:716-672-8060
Practice Address - Street 1:111 N MAPLEMERE RD STE 120
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3178
Practice Address - Country:US
Practice Address - Phone:716-836-4646
Practice Address - Fax:716-672-8060
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0857982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000511785004OtherBC FOR N. CHAUT RADIOL
NYCM1926OtherRAILROAD MEDICARE
NY01246304Medicaid
NY161435431OtherFIDELIS
NY000267043002OtherUNIVERA
NY000511785003OtherBLUE CROSS
NY00026704301OtherUNIV FOR N. CHAUT RAD
NY5609140OtherINDEPENDENT HEALTH
NY161435431OtherFIDELIS
NY00026704301OtherUNIV FOR N. CHAUT RAD
NY5609140OtherINDEPENDENT HEALTH