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Individual
LOUIS JOHN DIFAZIO
Active
Individual
LOUIS JOHN DIFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
151941-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00872546
—
NY
01
—
35D611
PTAN
NY
Enumeration date
08/02/2005
Last updated
11/27/2013
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