Individual
DR. IRA L. FASTLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 E SUNRISE HWY, SUITE 201, LINDENHURST, NY 11757-2598
(631) 225-7200
(631) 930-9451
Mailing address
150 E SUNRISE HWY, SUITE 201, LINDENHURST, NY 11757-2598
(631) 225-7200
(631) 930-9451
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
161418
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01207381
—
NY
Enumeration date
04/26/2006
Last updated
09/05/2012
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