Individual
MICHAEL FANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
105 - 04 SUTPHIN BLVD, JAMAICA, NY 11432
(855) 681-8700
(718) 943-6788
Mailing address
105 - 04 SUTPHIN BLVD, JAMAICA, NY 11435
(718) 725-5000
(718) 725-5080
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
332757
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LICENSE NUMBER
332757
NY
Enumeration date
08/19/2006
Last updated
12/05/2012
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