Provider Demographics
NPI:1114054376
Name:FASANO, FRANK (PA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:FASANO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE STE 300
Mailing Address - Street 2:SOMERS ORTHOPAEDIC SURGERY & SPORTS MED GROUP PLLC
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3990
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:664 STONELEIGH AVE STE 300
Practice Address - Street 2:SOMERS ORTHOPAEDIC SURGERY & SPORTS MED GROUP PLLC
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3990
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4326
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT1910363A00000X
NYP55922363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97F24CJ511OtherMEDICARE PIN
NY97F24CJ511Medicare PIN
NY4682510001Medicare NSC
NY4682510004Medicare NSC