| Doctor Name: | JOHN J FAZIO |
| NPI Number: | 1356364251 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRNA |
| License Number: | 375601 |
| Business Practice Address: | 201 Manor Pl Greenport, NY - 119441222 |
| Business Phone Number: | 6314771000 |
| Business Fax Number: | |
| Mailing Address: | 201 Manor Pl, GREENPORT |
| State: | NY |
| Postal Code: | 119441222 |
| Phone Number: | 6314771000 |
| Fax Number: | |
| NPI Enumeration Date: | 07/25/2006 |
| NPI Last Update Date: | 05/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0000X |
| License Number: | 375601 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pain Management |
| Taxonomy Definition: | |