Healthcare Provider Details

I. General information

NPI: 1619419256
Provider Name (Legal Business Name): DANIEL FACER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 1/2 PEMBROKE RD
DANBURY CT
06811-2954
US

IV. Provider business mailing address

33 1/2 PEMBROKE RD
DANBURY CT
06811-2954
US

V. Phone/Fax

Practice location:
  • Phone: 203-743-6471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6348
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: