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Organization
URANTIA MEDICAL PC
Active
Organization
URANTIA MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MODESTO FONTANEZ M.D. (PRINCIPAL)
(516) 365-4040
Entity
Organization
Contact information
Practice address
1295 NORTHERN BLVD, SUITE 20, MANHASSET, NY 11030-3035
(516) 365-4040
Mailing address
1295 NORTHERN BLVD, MANHASSET, NY 11030-3035
(516) 365-4040
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1818101
NY
174400000X
Specialist
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01583586
—
NY
Enumeration date
03/02/2012
Last updated
03/23/2012
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