Healthcare Provider Details

I. General information

NPI: 1619384252
Provider Name (Legal Business Name): SEPIDEH FAEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528
US

IV. Provider business mailing address

275 NORTH ST
HARRISON NY
10528-1140
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-6500
  • Fax:
Mailing address:
  • Phone: 914-967-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number291859-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: