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NPI Code Detail

MEDICARE: DR. NICK GERALD FARACI MD

MEDICARE:  DR. NICK GERALD FARACI  MD
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
1208000000XPediatrics Physician159197NY

General Provider Information

NPI Number : 1235104662
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICK GERALD FARACI MD
Provider Business Mailing Address
First Line : 4982 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6399
Country : US
Telephone Number : 718-967-6200
Fax Number : 718-967-6314
Provider Business Practice Location Address
First Line : 1407 W 6TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-4802
Country : US
Telephone Number : 718-256-1052
Fax Number : 718-256-4912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 07/30/2014

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Directions to “ DR. NICK GERALD FARACI MD” Practice Location

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