Healthcare Provider Details

I. General information

NPI: 1669567640
Provider Name (Legal Business Name): STEVEN ALAN FAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E 74TH ST
NEW YORK NY
10021
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: 212-249-2454
Mailing address:
  • Phone: 212-628-6208
  • Fax: 212-249-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number12050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: