MEDICARE: WILLIAM FONFEDER

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	173000000X	Legal Medicine	188439	NY

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	:	1568534964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM FONFEDER

Provider Business Mailing Address
First Line	:	1472 53RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3948
Country	:	US
Telephone Number	:	718-438-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1472 53RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3948
Country	:	US
Telephone Number	:	718-438-2309
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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