Jake Defonzo, PA-C is a medicare enrolled "Physician Assistant" in Penn Wynne, Pennsylvania. He graduated from nursing school in 2017 and has 8 years of diverse experience with area of expertise as Physician Assistant. His current practice location is
100 E Lancaster Ave, Penn Wynne, Pennsylvania. You can reach out to his office (for appointments etc.) via phone at
(484) 476-2000.
Jake Defonzo is licensed to practice in Pennsylvania (license number MA066534) and he also participates in the medicare program. He
may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1013502459.
Provider's Profile
| Full Name | Jake Defonzo |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 8 Years |
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| Location | 100 E Lancaster Ave, Penn Wynne, Pennsylvania |
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| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jake Defonzo graduated from nursing school in 2017
NPI Data:
- NPI Number: 1013502459
- Provider Enumeration Date: 03/08/2021
- Last Update Date: 09/01/2025
Medicare PECOS Information:
- PECOS PAC ID: 7810396090
- Enrollment ID: I20250821002798
Medical Identifiers
Medical identifiers for Jake Defonzo such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1013502459 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 026221-01 (New York) | Secondary |
| 363A00000X | Physician Assistant | MA066534 (Pennsylvania) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jake Defonzo is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jake Defonzo, PA-C
100 E Lancaster Ave,
Penn Wynne, PA 19096-3450
Ph: (484) 476-2000 | Jake Defonzo, PA-C
100 E Lancaster Ave,
Penn Wynne, PA 19096-3450
Ph: (484) 476-2000 |
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