Individual ProviderTheresa Lynne FazzolariPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address150 55th St, Brooklyn, NY 11220-2508(718) 630-7000PECOS EnrollmentBased on the most recent information from CMS, provider Theresa Lynne Fazzolari does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1659628717Provider TypeIndividualFull NameFazzolari, Theresa LynneCredentialP.A.GenderFemaleSole ProprietorYesEnumeration Date8/8/2012Last Updated8/8/2012Contact InformationPractice LocationPractice Address150 55th St, Brooklyn, NY 11220-2508Phone(718) 630-7000FaxUnlisted FaxMailing LocationMailing Address150 55th St, Brooklyn, NY 11220-2508PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense004688New York