Provider Demographics
NPI:1457540601
Name:FASANO, JOSEPH A (NP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:FASANO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:554 LARKFIELD RD
Mailing Address - Street 2:STE 10A
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4205
Mailing Address - Country:US
Mailing Address - Phone:631-239-1974
Mailing Address - Fax:631-239-1975
Practice Address - Street 1:280 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-9182
Practice Address - Country:US
Practice Address - Phone:631-758-4444
Practice Address - Fax:631-758-1984
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF304658-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health