Provider Demographics
NPI:1437105426
Name:FAZZARI, DOMINICK M (DC)
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:M
Last Name:FAZZARI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 38TH ST
Mailing Address - Street 2:200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9819
Mailing Address - Country:US
Mailing Address - Phone:212-682-4311
Mailing Address - Fax:212-682-2799
Practice Address - Street 1:308 E 38TH ST
Practice Address - Street 2:200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9819
Practice Address - Country:US
Practice Address - Phone:212-682-4311
Practice Address - Fax:212-682-2799
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor