Provider Demographics
NPI:1043680077
Name:FONTE SURGICAL SUPPLY, INC.
Entity type:Organization
Organization Name:FONTE SURGICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-338-1000
Mailing Address - Street 1:PO BOX 17890
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-0890
Mailing Address - Country:US
Mailing Address - Phone:585-338-1000
Mailing Address - Fax:585-338-2696
Practice Address - Street 1:1900 CLINTON AVE S
Practice Address - Street 2:SUITE320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5621
Practice Address - Country:US
Practice Address - Phone:585-244-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01361302Medicaid