Provider Demographics
NPI:1245720051
Name:FORTUNATO, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:FORTUNATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 YONKERS AVE APT 5M
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6246
Mailing Address - Country:US
Mailing Address - Phone:914-299-3605
Mailing Address - Fax:
Practice Address - Street 1:435 S BROADWAY STE 10
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2371
Practice Address - Country:US
Practice Address - Phone:914-751-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi