MEDICARE: DWIGHT BENEDICT FAUSTINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	40QA01201000	NJ

General Provider Information

NPI Number	:	1720112097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWIGHT BENEDICT FAUSTINO

Provider Business Mailing Address
First Line	:	11 CARRIAGE CT
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-2841
Country	:	US
Telephone Number	:	201-660-2484
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 CARRIAGE CT
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-2841
Country	:	US
Telephone Number	:	201-660-2484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	03/16/2023

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Directions to “ DWIGHT BENEDICT FAUSTINO ” Practice Location

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