Healthcare Provider Details

I. General information

NPI: 1649204272
Provider Name (Legal Business Name): JOAN HASSEL FACELLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SANITORIUM RD BUILDING D
POMONA NY
10970-3555
US

IV. Provider business mailing address

34 ROSE HILL ROAD
SUFFERN NY
10901
US

V. Phone/Fax

Practice location:
  • Phone: 845-364-2515
  • Fax: 845-364-2628
Mailing address:
  • Phone: 845-357-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number153156-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: