Provider Demographics
NPI:1740453281
Name:FASZCZEWSKI, LINDA A (NP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:A
Last Name:FASZCZEWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:FASZCZEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:895 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1248
Mailing Address - Country:US
Mailing Address - Phone:631-734-8088
Mailing Address - Fax:
Practice Address - Street 1:200 PANTIGO PL
Practice Address - Street 2:SUITE I
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5920
Practice Address - Country:US
Practice Address - Phone:631-329-8430
Practice Address - Fax:631-329-8291
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300559363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health