Provider Demographics
NPI:1801252630
Name:FONTAINE, GELENI (L AC)
Entity type:Individual
Prefix:
First Name:GELENI
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 8TH ST
Mailing Address - Street 2:APT A1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6916
Mailing Address - Country:US
Mailing Address - Phone:718-940-9343
Mailing Address - Fax:
Practice Address - Street 1:380 MARLBOROUGH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5618
Practice Address - Country:US
Practice Address - Phone:718-940-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist