MEDICARE: DR. ROSALBA FASANO D.C.

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	111N00000X	Chiropractor	X008729	NY

General Provider Information

NPI Number	:	1437177383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSALBA FASANO D.C.

Provider Business Mailing Address
First Line	:	3518 AVENUE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4828
Country	:	US
Telephone Number	:	718-332-2796
Fax Number	:	718-332-0649

Provider Business Practice Location Address
First Line	:	3518 AVENUE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4828
Country	:	US
Telephone Number	:	718-332-2796
Fax Number	:	718-332-0649

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	09/21/2015

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