Jake Defonzo, PA-C
Jake Defonzo, PA-C is a Physician Assistant in Penn Wynne, Pennsylvania. Qualified in 2017, 9 years ago. Licensed in New York and Pennsylvania.
- Years since qualifying
- 9
- Licensed in
- NY, PA
- In the registry since
- 2021
- Specialties on file
- 2
What do these letters mean?
- PA-C — Physician Assistant, Certified
- A physician assistant who holds current national certification.
Practice location Address checks out
100 E Lancaster AvePenn Wynne, PA 19096-3450
Phone: (484) 476-2000
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Physician Assistant (primary) | Taxonomy 363A00000X · Licence MA066534 (PA) |
|---|---|
| Physician Assistant | Taxonomy 363A00000X · Licence 026221-01 (NY) |
Record details
| NPI number | 1013502459 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | PA-C |
| Sole proprietor | No |
| NPI enumerated | March 8, 2021 |
| Last updated in NPPES | September 1, 2025 |
| Certification date | September 1, 2025 |
Medicare enrollment
| Medicare specialty | PHYSICIAN ASSISTANT |
|---|---|
| Medical school | OTHER |
| Graduated | 2017 (9 years in practice) |
| Accepts Medicare assignment | Not indicated |
| Practice locations | 2 on file with Medicare |