Healthcare Provider Details

I. General information

NPI: 1407172174
Provider Name (Legal Business Name): JOHN JOSEPH FARIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 CLINTON AVE S SUITE 200
ROCHESTER NY
14618-2663
US

IV. Provider business mailing address

2365 CLINTON AVE S SUITE 200
ROCHESTER NY
14618-2663
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-5700
  • Fax: 585-758-1299
Mailing address:
  • Phone: 585-758-5700
  • Fax: 585-758-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number281811
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number281811
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number281811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: