Provider Demographics
NPI:1285856443
Name:FONTANELLA, DAVID A (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:FONTANELLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 UNION BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512
Mailing Address - Country:US
Mailing Address - Phone:973-720-1700
Mailing Address - Fax:973-720-1701
Practice Address - Street 1:290 UNION BLVD
Practice Address - Street 2:STE 1
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2610
Practice Address - Country:US
Practice Address - Phone:973-720-1700
Practice Address - Fax:973-720-1701
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU72603Medicare UPIN