Provider Demographics
NPI:1194849984
Name:FASLER, BRIAN ROBERT (MA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ROBERT
Last Name:FASLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 N MAPLE AVE
Mailing Address - Street 2:APT. 26
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1700
Mailing Address - Country:US
Mailing Address - Phone:856-985-1403
Mailing Address - Fax:856-985-1014
Practice Address - Street 1:31 N MAPLE AVE
Practice Address - Street 2:APT. 26
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1700
Practice Address - Country:US
Practice Address - Phone:856-985-1403
Practice Address - Fax:856-985-1014
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00070000231H00000X
NJ25MG00105200237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter