Healthcare Provider Details

I. General information

NPI: 1225434418
Provider Name (Legal Business Name): DANIEL FAUSTIN MEDICAL PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 PARK AVE S
NEW YORK NY
10016-6822
US

IV. Provider business mailing address

41 DORAL DR
MANHASSET NY
11030-3907
US

V. Phone/Fax

Practice location:
  • Phone: 212-473-6500
  • Fax:
Mailing address:
  • Phone: 516-639-5535
  • Fax: 516-365-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number135376
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL FAUSTIN
Title or Position: PRESIDENT
Credential: MD
Phone: 516-639-5535