Healthcare Provider Details

I. General information

NPI: 1477609931
Provider Name (Legal Business Name): GIANNI L FAEDDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 50TH ST SUITE 2A
NEW YORK NY
10022-7752
US

IV. Provider business mailing address

245 E 50TH ST SUITE 2A
NEW YORK NY
10022-7752
US

V. Phone/Fax

Practice location:
  • Phone: 212-644-3111
  • Fax: 212-644-3119
Mailing address:
  • Phone: 212-644-3111
  • Fax: 212-644-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number195412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: