Provider Demographics
NPI:1437177383
Name:FASANO, ROSALBA (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSALBA
Middle Name:
Last Name:FASANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 AVENUE S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4828
Mailing Address - Country:US
Mailing Address - Phone:718-332-2796
Mailing Address - Fax:718-332-0649
Practice Address - Street 1:3518 AVENUE S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4828
Practice Address - Country:US
Practice Address - Phone:718-332-2796
Practice Address - Fax:718-332-0649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7A631Medicare ID - Type Unspecified
NYU74032Medicare UPIN