Healthcare Provider Details

I. General information

NPI: 1710923081
Provider Name (Legal Business Name): ROBERT FAZIO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY RD SUITE 100
PLAINVIEW NY
11803-4908
US

IV. Provider business mailing address

651 OLD COUNTRY RD SUITE 100
PLAINVIEW NY
11803-4908
US

V. Phone/Fax

Practice location:
  • Phone: 516-935-1958
  • Fax: 516-827-0714
Mailing address:
  • Phone: 516-935-1958
  • Fax: 516-827-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026070-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: