Provider Demographics
NPI:1073672572
Name:LEONARD A . FASANO
Entity Type:Organization
Organization Name:LEONARD A . FASANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:PULLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-387-2569
Mailing Address - Street 1:980 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1733
Mailing Address - Country:US
Mailing Address - Phone:203-387-2569
Mailing Address - Fax:203-387-9245
Practice Address - Street 1:980 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1733
Practice Address - Country:US
Practice Address - Phone:203-387-2569
Practice Address - Fax:203-387-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty