Healthcare Provider Details

I. General information

NPI: 1760408199
Provider Name (Legal Business Name): ALFRED F. FAUST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LINCOLN AVE
ROCKVILLE CENTRE NY
11570-5768
US

IV. Provider business mailing address

1728 SUNRISE HWY
MERRICK NY
11566-3745
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-2800
  • Fax:
Mailing address:
  • Phone: 516-992-4700
  • Fax: 516-992-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number248393
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number248393
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: