Individual
EDWARD FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4010 FORLEY ST, ELMHURST, NY 11373-1427
(718) 565-6565
(718) 565-6999
Mailing address
4010 FORLEY ST, ELMHURST, NY 11373-1427
(718) 565-6565
(718) 565-6999
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
311410
NY
Other
Enumeration date
09/25/2023
Last updated
07/12/2024
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