Healthcare Provider Details

I. General information

NPI: 1912642919
Provider Name (Legal Business Name): JOHN ADEL FALTAOUS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 SE INDIAN ST STE 102
STUART FL
34997-5689
US

IV. Provider business mailing address

203 CLIFFVIEW DR
HUNTINGTON WV
25704-8811
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-9000
  • Fax:
Mailing address:
  • Phone: 304-360-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: