Healthcare Provider Details

I. General information

NPI: 1750580726
Provider Name (Legal Business Name): PAULINE FANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CENTER DR
ROSLYN NY
11576-1447
US

IV. Provider business mailing address

PO BOX 13
ROSLYN HEIGHTS NY
11577-0013
US

V. Phone/Fax

Practice location:
  • Phone: 516-699-7790
  • Fax: 516-870-5770
Mailing address:
  • Phone: 516-699-7790
  • Fax: 516-870-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number230218
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number230218
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number230218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: