Provider Demographics
NPI:1063972560
Name:FONTIMAYOR, JHOLLIE
Entity type:Individual
Prefix:
First Name:JHOLLIE
Middle Name:
Last Name:FONTIMAYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ELGAR PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5103
Mailing Address - Country:US
Mailing Address - Phone:646-226-3785
Mailing Address - Fax:
Practice Address - Street 1:120 ELGAR PL APT 3G
Practice Address - Street 2:3G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5149
Practice Address - Country:US
Practice Address - Phone:646-226-3785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician