Healthcare Provider Details

I. General information

NPI: 1992027643
Provider Name (Legal Business Name): ROBIN FAULK NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2576 BROADWAY #510
NEW YORK NY
10025-5654
US

IV. Provider business mailing address

PO BOX 5756
ALBANY NY
12205-0756
US

V. Phone/Fax

Practice location:
  • Phone: 646-827-9568
  • Fax:
Mailing address:
  • Phone: 646-827-9568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338301
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00491000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: