Provider Demographics
NPI:1083905210
Name:FASANO, ANNMARIE JUDITH (RDMS)
Entity Type:Individual
Prefix:MS
First Name:ANNMARIE
Middle Name:JUDITH
Last Name:FASANO
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 74TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2613
Mailing Address - Country:US
Mailing Address - Phone:718-207-4853
Mailing Address - Fax:
Practice Address - Street 1:537 74TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2613
Practice Address - Country:US
Practice Address - Phone:718-207-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1091452471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography