Individual
MICHAEL FASTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
260 MIDDLE COUNTRY RD, SUITE 208, SMITHTOWN, NY 11787-2982
(631) 863-3223
(631) 863-3334
Mailing address
260 MIDDLE COUNTRY RD, SUITE 208, SMITHTOWN, NY 11787-2982
(631) 863-3223
(631) 863-3334
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2006-01943
NC
207N00000X
Dermatology Physician
Primary
252150-1
NY
Other
Enumeration date
05/03/2007
Last updated
01/26/2011
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