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General NPI Number Information
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NPI Number | 1225434418
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Entity Type | Organization
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Legal Business Name | DANIEL FAUSTIN MEDICAL PRACTICE, PLLC
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 461 PARK AVE S
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City | NEW YORK
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State | NY
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Zip | 10016-6822
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Country | US
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Telephone | 212-473-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 41 DORAL DR
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City | MANHASSET
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State | NY
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Zip | 11030-3907
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Country | US
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Telephone | 516-639-5535
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Fax | 516-365-1570
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL FAUSTIN
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Credential | MD
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Telephone | 516-639-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 135376
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License Number State | NY
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