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General NPI Number Information
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NPI Number | 1417806829
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Entity Type | Individual
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Provider Name | CORDELL JOSEPH FONTANA
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Gender | Male
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 1728 SUNRISE HWY
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City | MERRICK
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State | NY
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Zip | 11566-3745
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Country | US
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Telephone | 516-279-3352
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Fax |
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Provider Business Mailing Address
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Address Line | 18 MAPLE DR
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City | LINDENHURST
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State | NY
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Zip | 11757-1308
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Country | US
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Telephone | 516-302-5930
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NY
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