MEDICARE: MR. JUSTIN FAUDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	46TR01152800	NJ

General Provider Information

NPI Number	:	1184476947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN FAUDER

Provider Business Mailing Address
First Line	:	270 STEVENS AVE # 1
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-1314
Country	:	US
Telephone Number	:	551-655-5535
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 OUTWATER LN
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2629
Country	:	US
Telephone Number	:	973-955-2190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/04/2024

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Directions to “ MR. JUSTIN FAUDER ” Practice Location

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