Provider Demographics
NPI:1003913807
Name:FOND, JASON E (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:FOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 AIRPORT EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5288
Mailing Address - Country:US
Mailing Address - Phone:845-425-0555
Mailing Address - Fax:845-426-6126
Practice Address - Street 1:408 AIRPORT EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5288
Practice Address - Country:US
Practice Address - Phone:845-425-0555
Practice Address - Fax:845-426-6126
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230677-1207X00000X
NY203677-1207XX0005X
NJ25MA07243300207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2523530OtherOXFORD
NY8796768OtherCIGNA
NY403F21OtherEMPIRE BC/BS
NY4C5309OtherPHS-HEALTHNET
NY2635499OtherUSHC-HMO
NY35151OtherGHI-MEDICARE
NY9625142OtherGHI-FLEX SELECT
NY200041872OtherRAILROAD MEDICARE
NY7881295OtherAETNA-PPO/POS
NYH35597Medicare UPIN
NY200041872OtherRAILROAD MEDICARE
NY403F21Medicare ID - Type UnspecifiedMEDICARE