Individual
MARK L DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 82ND ST, BROOKLYN, NY 11228
(718) 836-3721
(718) 259-6567
Mailing address
1301 82ND ST, BOX 26, BROOKLYN, NY 11228
(718) 836-3721
(718) 259-6567
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
178425
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01223358
—
NY
Enumeration date
02/08/2006
Last updated
09/23/2011
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