Provider Demographics
NPI:1205801511
Name:FONTANE, BARBARA (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:FONTANE
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 1:380 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10168-0002
Mailing Address - Country:US
Mailing Address - Phone:914-552-4687
Mailing Address - Fax:914-993-6334
Practice Address - Street 1:380 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-0002
Practice Address - Country:US
Practice Address - Phone:914-552-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2513462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50568Medicare UPIN
NY588BK1Medicare PIN