Healthcare Provider Details

I. General information

NPI: 1457577942
Provider Name (Legal Business Name): FANELL ALERTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LINDEN BLVD
BROOKLYN NY
11203-2818
US

IV. Provider business mailing address

412 LINDEN BLVD
BROOKLYN NY
11203-2818
US

V. Phone/Fax

Practice location:
  • Phone: 718-856-6800
  • Fax: 718-856-6877
Mailing address:
  • Phone: 718-856-6800
  • Fax: 718-856-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number151846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: