Provider Demographics
NPI:1568442283
Name:FONTE SURGICAL SUPPLY, INC
Entity Type:Organization
Organization Name:FONTE SURGICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-338-1000
Mailing Address - Street 1:892 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1718
Mailing Address - Country:US
Mailing Address - Phone:585-338-1000
Mailing Address - Fax:585-338-2696
Practice Address - Street 1:892 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1718
Practice Address - Country:US
Practice Address - Phone:585-338-1000
Practice Address - Fax:585-338-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01361302Medicaid
NY01361302Medicaid