Provider Demographics
NPI:1467487736
Name:FASANO, ARMAND P (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:P
Last Name:FASANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1255 BROAD ST
Mailing Address - Street 2:STE 104
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2805
Mailing Address - Country:US
Mailing Address - Phone:197-370-7705
Mailing Address - Fax:201-861-8878
Practice Address - Street 1:229 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2805
Practice Address - Country:US
Practice Address - Phone:201-869-0707
Practice Address - Fax:201-861-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06272000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6697402Medicaid