Individual
JOSE LUIS FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRPA-P
Contact information
Practice address
1727 AMSTERDAM AVE, NEW YORK, NY 10031-4611
(212) 694-9200
(212) 368-5608
Mailing address
1727 AMSTERDAM AVE, NEW YORK, NY 10031-4611
(212) 694-9200
(212) 368-5608
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
5688
NY
Other
Enumeration date
01/25/2022
Last updated
01/25/2022
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