Dr. Jeffrey Theodore Fondak
Prosthodontist
33054 State Route 26
Carthage
, New York 13619-8600
Dr. Jeffrey Theodore Fondak
Prosthodontist
33054 State Route 26
Carthage
, New York 13619-8600
(315) 493-9394
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About
Features
Specialties
- Prosthodontist
Languages spoken
- English
Location
First Address
- Dr. Jeffrey Theodore Fondak
- 33054 New York State Route #26
- Carthage, NY
- Zip : 13619-8600
- Fax : (315) 493-9394
- Phone : (315) 493-9393
Second Address
- Dr. Jeffrey Theodore Fondak
- 33054 State Route 26
- Carthage, NY
- Zip : 13619-8600
- Phone : (315) 493-2106
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0700X | Prosthodontist | 033273 | NY |
National Provider Identifier
| NPI | 1184730392 |
|---|---|
| Provider Name | Dr. Jeffrey Theodore Fondak |
| First Address | Carthage, NY 13619-8600 |
| Second Address | Carthage, NY 13619-8600 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/08/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 033273 | DENTAL LICENSE (01) | NY |
| 1342155 | UNITED CONCORDIA PROVIDER (01) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.