Provider Demographics
NPI:1538314463
Name:FIASCONARO&FIASCONARO,M.D.,P.C.
Entity Type:Organization
Organization Name:FIASCONARO&FIASCONARO,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTO
Authorized Official - Middle Name:G
Authorized Official - Last Name:FIASCONARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-748-8484
Mailing Address - Street 1:7502 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2906
Mailing Address - Country:US
Mailing Address - Phone:718-748-8484
Mailing Address - Fax:718-680-2011
Practice Address - Street 1:7502 COLONIAL RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2906
Practice Address - Country:US
Practice Address - Phone:718-748-8484
Practice Address - Fax:718-680-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133854173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00447287Medicaid