Healthcare Provider Details

I. General information

NPI: 1427335066
Provider Name (Legal Business Name): STEVEN A. FAYER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 E 74TH ST
NEW YORK NY
10021-3222
US

IV. Provider business mailing address

169 E 74TH ST
NEW YORK NY
10021-3222
US

V. Phone/Fax

Practice location:
  • Phone: 212-628-6208
  • Fax:
Mailing address:
  • Phone: 212-628-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number124050
License Number StateNY

VIII. Authorized Official

Name: DR. STEVEN A FAYER
Title or Position: PSYCHIATRIST
Credential:
Phone: 212-628-6208