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NPI Code Detail

MEDICARE: JOANNA FASULO DC PC

MEDICARE: JOANNA FASULO DC PC
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
1111N00000XChiropractorX006462NY

General Provider Information

NPI Number : 1336418847
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOANNA FASULO DC PC
Provider Business Mailing Address
First Line : 70 WILDWOOD ROAD SAG
Second Line :
City : HARBOR
State : NY
Zip : 11937
Country : US
Telephone Number : 516-509-0725
Fax Number :
Provider Business Practice Location Address
First Line : 4155 VETERANS MEMORIAL HWY STE 5
Second Line :
City : RONKONKOMA
State : NY
Zip : 11779-6063
Country : US
Telephone Number : 516-509-0725
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JOANNA FASULO
Credential : DC
Telephone Number : 516-509-0725
Provider Enumeration Date : 12/29/2011
Last Update Date : 03/13/2026

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Directions to “JOANNA FASULO DC PC ” Practice Location

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