MEDICARE: FONTE SURGICAL SUPPLY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043680077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FONTE SURGICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 17890
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-0890
Country	:	US
Telephone Number	:	585-338-1000
Fax Number	:	585-338-2696

Provider Business Practice Location Address
First Line	:	1900 CLINTON AVE S
Second Line	:	SUITE320
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5621
Country	:	US
Telephone Number	:	585-244-4747
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL D FONTE
Credential	:
Telephone Number	:	585-338-1000

Provider Enumeration Date	:	10/02/2015
Last Update Date	:	10/02/2015

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