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General NPI Number Information
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NPI Number | 1619116597
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Entity Type | Individual
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Provider Name | DAPENG FAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 06/24/2009
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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 | 718-818-2843
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Fax | 718-818-4709
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Provider Business Mailing Address
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Address Line | 1 BEACH 105TH ST APT. 1X
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2695
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Country | US
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Telephone | 201-804-2800
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Fax | 201-804-8883
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 253526
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License Number State | NY
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