Individual
MR. HANTZ BLAKE FONTAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
1 GUSTAVE L LEVY PL, DEPARTMENT OF SURGERY- MT. SINAI MEDICAL CENTER, NEW YORK, NY 10029-6574
(917) 829-0961
Mailing address
1302 AVENUE K APT 1H, BROOKLYN, NY 11230-4354
(917) 829-0961
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
013716
NY
Other
Enumeration date
01/16/2010
Last updated
01/16/2010
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