Provider Demographics
NPI:1710907415
Name:FONTANEZ, JOSE R (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:FONTANEZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CAREMOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:60 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2990
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:845-765-4989
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-11-27
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Provider Licenses
StateLicense IDTaxonomies
NY167247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01499018Medicaid
NY01499018Medicaid
NYA400026883Medicare PIN