=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164395414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATE LYNNE FONTES PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 2ND AVE
-----------------------------------------------------
City | LONG BRANCH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07740-6395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-222-5200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 BELGROVE DR
-----------------------------------------------------
City | KEARNY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07032-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-216-9500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 25MP00966500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------