Provider Demographics
NPI:1922004225
Name:TONTARSKI, FREDERICK G (PA)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:G
Last Name:TONTARSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612-0857
Mailing Address - Country:US
Mailing Address - Phone:315-773-8852
Mailing Address - Fax:315-773-4014
Practice Address - Street 1:32787 US RT 11
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:NY
Practice Address - Zip Code:13673
Practice Address - Country:US
Practice Address - Phone:315-642-0026
Practice Address - Fax:315-642-1028
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003616363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R89967Medicare UPIN