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General NPI Number Information
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NPI Number | 1073672572
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Entity Type | Organization
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Legal Business Name | LEONARD A . FASANO
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 980 WHALLEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06515-1733
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Country | US
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Telephone | 203-387-2569
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Fax | 203-387-9245
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Provider Business Mailing Address
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Address Line | 980 WHALLEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06515-1733
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Country | US
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Telephone | 203-387-2569
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Fax | 203-387-9245
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Authorized Official
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Title or Position | BILLING
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Name | MS. PAM M PULLANO
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Credential |
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Telephone | 203-387-2569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 08230
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License Number State | CT
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