=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821063116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMAN S. FASTMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2006
-----------------------------------------------------
Last Update Date | 10/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2291 HYLAN BLVD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-351-3515
-----------------------------------------------------
Fax | 718-351-2407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2291 HYLAN BLVD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-351-3515
-----------------------------------------------------
Fax | 718-351-2407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207KA0200X
-----------------------------------------------------
Taxonomy Name | Allergy Physician
-----------------------------------------------------
License Number | 81439
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------