MEDICARE: ALLISON L FACHES MD PA

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1245206531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLISON L FACHES MD PA

Provider Business Mailing Address
First Line	:	1 ETHEL RD
Second Line	:	SUITE 107B
City	:	EDISON
State	:	NJ
Zip	:	08817-2838
Country	:	US
Telephone Number	:	732-452-0057
Fax Number	:	732-287-2071

Provider Business Practice Location Address
First Line	:	1 ETHEL RD
Second Line	:	SUITE 107B
City	:	EDISON
State	:	NJ
Zip	:	08817-2838
Country	:	US
Telephone Number	:	732-452-0057
Fax Number	:	732-287-2071

Authorized Official
Title or Position	:	PRESIDENT ALLISON L FACHES MD PA
Name	:	DR. ALLISON L FACHES
Credential	:	MD
Telephone Number	:	732-452-0057

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	06/27/2012

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