Jake Defonzo, PA-C is a medicare enrolled "Physician Assistant" in Penn Wynne, Pennsylvania. 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 does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1013502459.
				
				
				
				
				
		 
		
		 
Provider's Profile
		
			
			
			| Full Name | Jake Defonzo | 
|---|
| Gender | Male | 
|---|
| Speciality | Physician Assistant | 
|---|
| Location | 100 E Lancaster Ave, Penn Wynne, Pennsylvania | 
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
|---|
			
			 
			
						  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: I20210519002733
 
		 
		 
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 | 
|---|
		| 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 | 
|---|
		| 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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