Provider Demographics
NPI:1467542779
Name:FONACIER, JOSE RIZAL B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE RIZAL
Middle Name:B
Last Name:FONACIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:42 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1942
Mailing Address - Country:US
Mailing Address - Phone:516-829-6298
Mailing Address - Fax:
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-742-4442
Practice Address - Fax:516-505-0768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149520207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY41Z881Medicare ID - Type Unspecified