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General NPI Number Information
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NPI Number | 1518018902
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Entity Type | Individual
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Provider Name | DAVID H FASTMAN MD
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 355 BARD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-1664
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Country | US
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Telephone | 718-818-4570
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Fax | 718-818-3715
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Provider Business Mailing Address
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Address Line | PO BOX 2003
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-4503
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Country | US
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Telephone | 315-446-3904
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Fax | 315-445-2936
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 150876
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License Number State | NY
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