Individual
JENNIFER L DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 VETERANS HWY, HAUPPAUGE, NY 11788-2948
(646) 227-3275
Mailing address
633 3RD AVE, BOX 3, NEW YORK, NY 10017-6706
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
240844
NY
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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