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General NPI Number Information
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NPI Number | 1144599333
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Entity Type | Individual
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Provider Name | GERARDO FONTAN JR. PHD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 41-51 EAST 11TH STREET 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10003
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Country | US
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Telephone | 347-541-5256
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1336
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City | NEW YORK
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State | NY
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Zip | 10113-1336
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Country | US
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Telephone | 917-470-2526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 019345
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License Number State | NY
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