Fasanya, Charles Timothy

Fasanya, Charles Timothy is an individual health care provider with primary practice located at 707 E Main St , Middletown NY 10940-2650. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgical Critical Care. Allopathic & Osteopathic Physicians / Surgical Critical Care is his primary health care specialty. Fasanya, Charles Timothy can be contacted via phone (845) 333-7575.

Contact Information

Primary practice address
707 E Main St Middletown NY 10940-2650
Phone: (845) 333-7575
Fax: (845) 333-1454
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 25MA08347800 New Jersey
Allopathic & Osteopathic Physicians / Surgical Critical Care 2086S0102X 254698 New York

Profile Details

NPI number 1710149356
LBN Legal business name Fasanya, Charles Timothy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 25th, 2008
Last updated Apr 2nd, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710149356 NPPES
New York Other 254698 NEW YORK STATE LICENSE
New York Other 25MA08347800 NEW YORK STATE LICENSE
New York MEDICAID 0181781 NEW YORK STATE LICENSE

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