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NPI Code Detail

MEDICARE: JAMIE FONTANA

MEDICARE: JAMIE FONTANA
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
1363A00000XPhysician Assistant

Other Identifiers

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

General Provider Information

NPI Number : 1396507711
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE FONTANA
Provider Business Mailing Address
First Line : 22 NICOLE LN
Second Line :
City : WINGDALE
State : NY
Zip : 12594-1343
Country : US
Telephone Number : 845-661-3882
Fax Number :
Provider Business Practice Location Address
First Line : 111 CLOCK TOWER CMNS
Second Line :
City : BREWSTER
State : NY
Zip : 10509-4055
Country : US
Telephone Number : 845-279-5187
Fax Number : 855-703-7570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2024
Last Update Date : 01/28/2026

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