Healthcare Provider Details

I. General information

NPI: 1053593400
Provider Name (Legal Business Name): EDWARD VINCENT FAUSTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR STREET
NEW HAVEN CT
06520-8064
US

IV. Provider business mailing address

333 CEDAR STREET PO BOX 208064
NEW HAVEN CT
06520-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4651
  • Fax: 203-785-5833
Mailing address:
  • Phone: 203-785-4651
  • Fax: 203-785-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045537
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number045537
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: