Healthcare Provider Details

I. General information

NPI: 1124502463
Provider Name (Legal Business Name): JOSHUA MARCO MITCHELL FABER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2018
Last Update Date: 05/02/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E HURON ST STE 1-200 NORTHWESTERN MEDICINE MCGAW MEDICAL CENTER
CHICAGO IL
60611-2909
US

IV. Provider business mailing address

525 E 68TH ST NEWYORK-PRESBYTERIAN WEILL CORNELL EMERGENCY DEPARTMENT
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-7975
  • Fax:
Mailing address:
  • Phone: 121-274-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: