Dr. John Edward Fantasia
Oral and Maxillofacial Pathology
27005 76th Ave Lijmc
New Hyde Park
, New York 11040-1433
Dr. John Edward Fantasia
Oral and Maxillofacial Pathology
27005 76th Ave Lijmc
New Hyde Park
, New York 11040-1433
(718) 347-3483
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About
Features
Specialties
- Oral and Maxillofacial Pathology
Languages spoken
- English
Location
First Address
- Dr. John Edward Fantasia
- 27005 76th Ave Lijmc
- New Hyde Park, NY
- Zip : 11040-1433
- Fax : (718) 347-3483
- Phone : (718) 470-7116
Second Address
- Dr. John Edward Fantasia
- 27005 76th Ave Lijmc
- New Hyde Park, NY
- Zip : 11040-1433
- Fax : (718) 347-3483
- Phone : (718) 470-7116
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0106X | Oral and Maxillofacial Pathology | 041799-1 | NY |
National Provider Identifier
| NPI | 1730258286 |
|---|---|
| Provider Name | Dr. John Edward Fantasia |
| First Address | New Hyde Park, NY 11040-1433 |
| Second Address | New Hyde Park, NY 11040-1433 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/11/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 01098053 | (05) | NY |
| T97049 | (02) | NY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.