Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MB08150900 | NJ |
Y | 208600000X | Surgeon | 25MB08150900 | NJ |
NPI | 1003922113 |
---|---|
Provider Name | Victor Fontana |
First Address | Secaucus, NJ 07094-4215 |
Second Address | Hazlet, NJ 07730-2041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 04/10/2011 |