Provider Demographics
NPI:1518611169
Name:FONTIN, MEDJY (RN)
Entity Type:Individual
Prefix:MRS
First Name:MEDJY
Middle Name:
Last Name:FONTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18735 MANGIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2315
Mailing Address - Country:US
Mailing Address - Phone:347-691-6868
Mailing Address - Fax:
Practice Address - Street 1:18735 MANGIN AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2315
Practice Address - Country:US
Practice Address - Phone:347-691-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY460082-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse