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General NPI Number Information
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NPI Number | 1184476947
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Entity Type | Individual
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Provider Name | MR. JUSTIN FAUDER
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Gender | Male
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Dates
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Enumeration Date | 04/04/2024
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 118 OUTWATER LN
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City | GARFIELD
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State | NJ
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Zip | 07026-2629
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Country | US
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Telephone | 973-955-2190
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Fax |
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Provider Business Mailing Address
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Address Line | 270 STEVENS AVE # 1
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City | JERSEY CITY
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State | NJ
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Zip | 07305-1314
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Country | US
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Telephone | 551-655-5535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 46TR01152800
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License Number State | NJ
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