1023112422 NPI number — DR. WILLIAM ALBERT FAZZINO DC

Table of content: DR. WILLIAM ALBERT FAZZINO DC (NPI 1023112422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023112422 NPI number — DR. WILLIAM ALBERT FAZZINO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAZZINO
Provider First Name:
WILLIAM
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023112422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 PINOAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-294-0113
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 WORCESTER ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
NORTH GRAFTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-839-9100
Provider Business Practice Location Address Fax Number:
508-839-9100
Provider Enumeration Date:
09/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1767 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 0329 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)