MEDICARE: ANTHONY FASCIANO 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	207R00000X	Internal Medicine Physician	175805	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396102620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY FASCIANO M.D.

Provider Business Mailing Address
First Line	:	1748 71ST ST APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5227
Country	:	US
Telephone Number	:	347-641-3210
Fax Number	:	866-824-7488

Provider Business Practice Location Address
First Line	:	1748 71ST ST APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5227
Country	:	US
Telephone Number	:	347-641-3210
Fax Number	:	866-834-7488

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

Provider Enumeration Date	:	01/17/2016
Last Update Date	:	01/17/2016

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