Individual
MR. SAM M FASSNACHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 MEDFORD AVE, PATCHOGUE, NY 11772-1206
(631) 475-5734
Mailing address
130 MEDFORD AVE, PATCHOGUE, NY 11772-1206
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/27/2010
Last updated
12/28/2016
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