Provider Demographics
NPI:1386894509
Name:FONSECA, JUAN PABLO (M D)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:FONSECA
Suffix:
Gender:M
Credentials:M D
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1111 AMSTERDAM AVE
Mailing Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1716
Mailing Address - Country:US
Mailing Address - Phone:212-523-3981
Mailing Address - Fax:212-523-2186
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1716
Practice Address - Country:US
Practice Address - Phone:212-523-3981
Practice Address - Fax:212-523-2186
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2013-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY267760207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine