Individual
MR. ATANASIO GAETANO FAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
622 W 168TH ST, VC 10 AREA D, NEW YORK, NY 10032-3720
(212) 342-1627
(212) 342-2112
Mailing address
622 W 168TH ST, VC 10, RM 1001, NEW YORK, NY 10032-3720
(212) 342-1627
(212) 342-2112
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
018715
NY
Other
Enumeration date
04/10/2008
Last updated
10/19/2012
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