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General NPI Number Information
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NPI Number | 1467487736
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Entity Type | Individual
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Provider Name | ARMAND P FASANO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 229 60TH ST
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-2805
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Country | US
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Telephone | 201-869-0707
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Fax | 201-861-8878
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Provider Business Mailing Address
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Address Line | 1255 BROAD ST STE 104
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2805
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Country | US
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Telephone | 197-370-7705
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Fax | 201-861-8878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA06272000
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License Number State | NJ
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