Organization
JOHN A. FACCHIN, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A. FACCHIN O.D. (SOLE PROPRIETOR)
(516) 798-2635
Entity
Organization
Contact information
Practice address
111 GRAND AVE, MASSAPEQUA, NY 11758-4905
(516) 798-2635
Mailing address
1 MAPLE ST, MASSAPEQUA, NY 11758-5718
(516) 220-7787
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0978400001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01474419
—
NY
Enumeration date
12/06/2007
Last updated
11/05/2008
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