Provider Demographics
NPI:1508563867
Name:FAZZARI, ALEXANDER PAUL
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:PAUL
Last Name:FAZZARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MCDONALD ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1231
Mailing Address - Country:US
Mailing Address - Phone:908-319-2809
Mailing Address - Fax:
Practice Address - Street 1:58 MCDONALD ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1231
Practice Address - Country:US
Practice Address - Phone:908-319-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer