Provider Demographics
NPI:1962689133
Name:FONDER, MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:FONDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STATE RT 17 STE 2
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2013
Mailing Address - Country:US
Mailing Address - Phone:201-652-4536
Mailing Address - Fax:201-652-4906
Practice Address - Street 1:400 ROUTE 17 STE 2
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2013
Practice Address - Country:US
Practice Address - Phone:201-652-4536
Practice Address - Fax:201-652-4906
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0011435Medicare PIN