Individual
CAMILLE FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(187) 920-4316
(718) 881-2245
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(187) 920-4316
(718) 881-2245
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
305487
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
305487
NY
Other
Enumeration date
04/07/2015
Last updated
01/13/2021
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