Individual
DR. MODESTO FONTANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2805 VETERANS MEMORIAL HWY, SUITE 8, RONKONKOMA, NY 11779-7647
(631) 738-8300
(631) 738-8500
Mailing address
2805 VETERANS MEMORIAL HWY, SUITE 8, RONKONKOMA, NY 11779-7647
(631) 738-8300
(631) 738-8500
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
181810-4
NY
207T00000X
Neurological Surgery Physician
35083857
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2463258
—
OH
Enumeration date
06/08/2005
Last updated
01/04/2012
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