Healthcare Provider Details

I. General information

NPI: 1619024031
Provider Name (Legal Business Name): ERIKA N FAUST D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 57TH ST STE. 512
NEW YORK NY
10019-2303
US

IV. Provider business mailing address

474 48TH AVE APT. 38E
LONG ISLAND CITY NY
11109-5600
US

V. Phone/Fax

Practice location:
  • Phone: 212-262-2948
  • Fax: 212-262-4047
Mailing address:
  • Phone: 646-872-3508
  • Fax: 718-606-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: