Provider Demographics
NPI:1972742492
Name:ARMAND P. FASANO, M.D., PA
Entity Type:Organization
Organization Name:ARMAND P. FASANO, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPHTHALMOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMAND
Authorized Official - Middle Name:PIETRO
Authorized Official - Last Name:FASANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-869-0707
Mailing Address - Street 1:229 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2805
Mailing Address - Country:US
Mailing Address - Phone:201-869-0707
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06272000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty