Healthcare Provider Details

I. General information

NPI: 1891757381
Provider Name (Legal Business Name): ALBERT FAUROSS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6511
  • Fax: 516-572-3210
Mailing address:
  • Phone: 516-572-6511
  • Fax: 516-572-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number004680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: