Provider Demographics
NPI:1821063116
Name:FASTMAN, NORMAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:S
Last Name:FASTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3231
Mailing Address - Country:US
Mailing Address - Phone:718-351-3515
Mailing Address - Fax:718-351-2407
Practice Address - Street 1:2291 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3231
Practice Address - Country:US
Practice Address - Phone:718-351-3515
Practice Address - Fax:718-351-2407
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY81439207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB 10691Medicare UPIN