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General NPI Number Information
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NPI Number | 1861652109
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Entity Type | Individual
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Provider Name | NANCY C. FONTANA AU.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 1500 ROUTE 112 BLDG #4, 2ND FLOOR
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City | PORT JEFFERSON
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State | NY
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Zip | 11776
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Country | US
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Telephone | 631-928-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 660 WHITE PLAINS ROAD - ENTA FOURTH FLOOR
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City | TARRYTOWN
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State | NY
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Zip | 10591-6802
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Country | US
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Telephone | 914-984-2552
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1649
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License Number State | NY
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