MEDICARE: DR. CHRISTOPHER JOHN FAZIO V.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174M00000X	Veterinarian	29VI00312900	NJ

General Provider Information

NPI Number	:	1144485285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN FAZIO V.M.D.

Provider Business Mailing Address
First Line	:	424 SILVER LAKE RD
Second Line	:
City	:	BLAIRSTOWN
State	:	NJ
Zip	:	07825-3662
Country	:	US
Telephone Number	:	908-459-9308
Fax Number	:	908-459-5921

Provider Business Practice Location Address
First Line	:	424 SILVER LAKE RD
Second Line	:
City	:	BLAIRSTOWN
State	:	NJ
Zip	:	07825-3662
Country	:	US
Telephone Number	:	908-459-9308
Fax Number	:	908-459-5921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/28/2008

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