NPIMap

Individual provider Active NPI

Arnold Glen Fontanilla, D.O.

  • Family Medicine Physician
  • Pennsauken, NJ
National Provider Identifier
1720191778
Registry record updated Oct 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB07716400 Issued in NJ
Practice address
6981 North Park Drive
Coooper River West Office Building
Pennsauken, NJ 08109
Phone
(856) 663-4949
Fax
(856) 663-6076
NPI assigned
Aug 16, 2006
Last updated
Oct 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MB07716400 NJ Primary
Family Medicine Physician 207Q00000X OS012536 PA

Addresses

Primary practice location

6981 North Park Drive
Coooper River West Office Building
Pennsauken, NJ 08109

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other identifiers 1

IdentifierTypeStateIssuer
1014376180001MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address afontanilla115688@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160219000218 NJ Practitioner - Family Practice 9830154459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Physicians and Surgeons, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

3242 Route 206
Bordentown, NJ 08505-4517

6981 N Park Dr
Pennsauken, NJ 08109-4201

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
25MB07716400NJMDFamily Medicine Physician
OS012536PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Nov 1, 2020 Accepting new patients
Virtua Medical Group, PA Family Medicine Current Accepting new patients
Virtua Medical Group, PA CurrentSince Nov 1, 2020 Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

141 Route 70 E
Ste E
Marlton, NJ 08053
Phone (856) 985-7373

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

303 Lippincott Dr
Marlton, NJ 08053

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1720191778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6981 NORTH PARK DRIVE",
            "address_2": "COOOPER RIVER WEST OFFICE BUILDING",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "08109",
            "telephone_number": "856-663-4949",
            "fax_number": "856-663-6076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTANILLA",
        "first_name": "ARNOLD",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB07716400",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS012536",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014376180001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "afontanilla115688@directvirtua.org",
            "affiliation": "N",
            "address_1": "6981 North Park Drive",
            "address_2": "Coooper River West Office Building",
            "city": "Pennsauken",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "08109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pennsauken, NJ

Sources for this page

Verify at the official NPI Registry.