Provider Demographics
NPI:1134014988
Name:FAIRLEY, NORMAN S
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:S
Last Name:FAIRLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 THE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1422
Mailing Address - Country:US
Mailing Address - Phone:516-315-8585
Mailing Address - Fax:
Practice Address - Street 1:40 THE BLVD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1422
Practice Address - Country:US
Practice Address - Phone:516-315-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator