NPIMap

Individual provider Active NPI

Modesto Fontanez, M.D.

  • Neurological Surgery Physician
  • Ronkonkoma, NY
National Provider Identifier
1851395826
Registry record updated Jan 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
181810-4 Issued in NY
Practice address
2805 Veterans Memorial Hwy
Suite 8
Ronkonkoma, NY 11779-7647
Phone
(631) 738-8300
Fax
(631) 738-8500
NPI assigned
Jun 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 35083857 OH
Neurological Surgery Physician 207T00000X 181810-4 NY Primary

Addresses

Primary practice location

2805 Veterans Memorial Hwy
Suite 8
Ronkonkoma, NY 11779-7647

Mailing address

2805 Veterans Memorial Hwy
Suite 8
Ronkonkoma, NY 11779-7647
Phone (631) 738-8300

Other identifiers 1

IdentifierTypeStateIssuer
2463258MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
181810-4NYMDNeurological Surgery Physician
35083857OHMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York Neurosurgery & Neuroscience Associates Past Accepting new patients
University Group Medical Associates, P.C Past Accepting new patients
University of Toledo Physicians LLC Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325635200000",
    "number": "1851395826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 VETERANS MEMORIAL HWY",
            "address_2": "SUITE 8",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797647",
            "telephone_number": "631-738-8300",
            "fax_number": "631-738-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 VETERANS MEMORIAL HWY",
            "address_2": "SUITE 8",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797647",
            "telephone_number": "631-738-8300",
            "fax_number": "631-738-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTANEZ",
        "first_name": "MODESTO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2012-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OH",
            "license": "35083857",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "181810-4",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2463258",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.