Individual
JOHN J FAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 HEROES WAY, RIVERHEAD, NY 11901-2054
(631) 548-6000
Mailing address
480 BEDFORD RD STE 4202, CHAPPAQUA, NY 10514-1716
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
375601
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
375601
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356364251
MEDICARE RAILROAD
NY
Enumeration date
07/25/2006
Last updated
01/27/2025
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