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General NPI Number Information
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NPI Number | 1407920564
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Entity Type | Individual
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Provider Name | MAXINE ELIZABETH FACEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 32 CLINTON ST
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City | PATERSON
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State | NJ
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Zip | 07522-1775
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Country | US
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Telephone | 973-790-6594
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Fax |
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Provider Business Mailing Address
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Address Line | 218 WAVERLY PL
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2125
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Country | US
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Telephone | 973-327-4623
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07731000
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License Number State | NJ
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