Individual
ANTHONY FASULO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 CARLETON AVE, CENTRAL ISLIP, NY 11722-4506
(631) 663-4300
Mailing address
790 PARK AVE, HUNTINGTON, NY 11743-4516
(631) 427-3700
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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