Individual
RICHARD ANTHONY FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
78 TODT HILL RD, SUITE 203, STATEN ISLAND, NY 10314-4528
(718) 448-1122
(718) 448-8318
Mailing address
78 TODT HILL RD, SUITE 203, STATEN ISLAND, NY 10314-4528
(718) 448-1122
(718) 448-8318
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
140259
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0023395
GHI
NY
05
—
00767666
—
NY
Enumeration date
03/07/2006
Last updated
12/16/2011
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