| Richard A. Fazio Md, P.c. | |
|
78 Todt Hill Rd Suite 203 Staten Island NY 10314-4528 | |
| (718) 448-1122 | |
| (718) 448-8318 |
| Full Name | Richard A. Fazio Md, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 78 Todt Hill Rd, Staten Island, New York |
| Authorized Official Name and Position | Richard A Fazio (PRESIDENT) |
| Authorized Official Contact | 7184481122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard A. Fazio Md, P.c. 78 Todt Hill Rd Suite 203 Staten Island NY 10314-4528 Ph: (718) 448-1122 | Richard A. Fazio Md, P.c. 78 Todt Hill Rd Suite 203 Staten Island NY 10314-4528 Ph: (718) 448-1122 |
| NPI Number | 1447303128 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 04/14/2008 |
| Medicare PECOS PAC ID | 1153210570 |
|---|---|
| Medicare Enrollment ID | O20060126000308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447303128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Richard A Fazio |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1285601419 PECOS PAC ID: 6901892686 Enrollment ID: I20040421000051 |
| Provider Name | Yanyu Sun |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1821057340 PECOS PAC ID: 4587689070 Enrollment ID: I20051013000591 |
| Provider Name | Wallen C Chan |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1043287857 PECOS PAC ID: 3971515040 Enrollment ID: I20060608000278 |
| Provider Name | Vahe Sis Shahnazarian |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1265770085 PECOS PAC ID: 4486903960 Enrollment ID: I20200416001835 |
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