Provider Demographics
NPI:1447353651
Name:FANNO, BRIAN E (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:FANNO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 7TH AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7605
Mailing Address - Country:US
Mailing Address - Phone:917-960-4023
Mailing Address - Fax:212-503-3555
Practice Address - Street 1:469 7TH AVE STE 601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7605
Practice Address - Country:US
Practice Address - Phone:646-626-3033
Practice Address - Fax:347-287-6791
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0060041213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02637290Medicaid
NY02637290Medicaid
U99181Medicare UPIN