1003913807 NPI number — JASON E FOND MD

Table of content: JASON E FOND MD (NPI 1003913807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003913807 NPI number — JASON E FOND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOND
Provider First Name:
JASON
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003913807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 AIRPORT EXECUTIVE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-5288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-425-0555
Provider Business Mailing Address Fax Number:
845-426-6126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 AIRPORT EXECUTIVE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954-5288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-425-0555
Provider Business Practice Location Address Fax Number:
845-426-6126
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  230677-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 203677-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 25MA07243300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 25MA07243300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P2523530 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8796768 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 403F21 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C5309 . This is a "PHS-HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2635499 . This is a "USHC-HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 35151 . This is a "GHI-MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9625142 . This is a "GHI-FLEX SELECT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200041872 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7881295 . This is a "AETNA-PPO/POS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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