Provider Demographics
NPI:1952395246
Name:FONTANETTA, ADRIAN PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:PHILIP
Last Name:FONTANETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 STEWART AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4822
Mailing Address - Country:US
Mailing Address - Phone:516-222-2022
Mailing Address - Fax:516-222-8475
Practice Address - Street 1:137 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11301-4077
Practice Address - Country:US
Practice Address - Phone:516-741-8822
Practice Address - Fax:516-741-9351
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140740207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00500674Medicaid
NY200005301OtherRAILROAD MEDICARE
30A621Medicare ID - Type Unspecified
NY200005301OtherRAILROAD MEDICARE