Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JAKE DEFONZO, PA-C
ActiveJAKE DEFONZO, PA-C is a Physician Assistant healthcare provider located in PENN WYNNE, Pennsylvania. NPI 1013502459 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · PENN WYNNE, PA
Registration Details
- NPI Number
- 1013502459
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 8, 2021 (5.4252059818882 yrs)
- Last Updated
- Sep 1, 2025
- Licenses
-
026221-01 (NY)MA066534 (PA)
Practice Information
- Address
-
100 E LANCASTER AVEPENN WYNNE, PA, 190963450Browse PA providers · Browse ZIP 19096
- Phone
- 4844762000
- Primary Specialty
-
Physician Assistant
363A00000X
- Additional Specialty
- Physician Assistant
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.