MEDICARE: JAMIE FONTANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396507711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE FONTANA

Provider Business Mailing Address
First Line	:	22 NICOLE LN
Second Line	:
City	:	WINGDALE
State	:	NY
Zip	:	12594-1343
Country	:	US
Telephone Number	:	845-661-3882
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 CLOCK TOWER CMNS
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4055
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:	855-703-7570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/28/2026

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Directions to “ JAMIE FONTANA ” Practice Location

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