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General NPI Number Information
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NPI Number | 1922064880
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Entity Type | Individual
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Provider Name | LOUIS FAIELLA MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 04/02/2011
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Provider Practice Location Address
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Address Line | 1305 FRANKLIN AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-1657
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Country | US
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Telephone | 516-742-3200
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Fax | 516-746-5847
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Provider Business Mailing Address
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Address Line | 1305 FRANKLIN AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-1657
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Country | US
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Telephone | 516-742-3200
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Fax | 516-746-5847
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 196505
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License Number State | NY
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