Healthcare Provider Details

I. General information

NPI: 1003112947
Provider Name (Legal Business Name): BRIAN THOMAS ZAFONTE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FULLER ST
ALEXANDRIA BAY NY
13607-1391
US

IV. Provider business mailing address

3811 SPRING ST SUITE 102
MOUNT PLEASANT WI
53405-1667
US

V. Phone/Fax

Practice location:
  • Phone: 315-482-1251
  • Fax: 315-482-4847
Mailing address:
  • Phone: 262-687-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number312647
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number312647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: