Individual
AMIN FAZELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4110 MEDICAL CENTER DR, SUITE 110, FAYETTEVILLE, NY 13066-6613
(315) 663-0100
(585) 663-0052
Mailing address
4110 MEDICAL CENTER DR, DERMATOLOGY ASSOCIATES OF CNY PLLC, FAYETTEVILLE, NY 13066-6613
(315) 663-0100
(315) 663-0052
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
236051
NY
207ND0101X
MOHS-Micrographic Surgery Physician
236051
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RA7948
—
NY
Enumeration date
04/17/2006
Last updated
01/26/2017
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