MEDICARE: DR. ALAN HERBERT FAUSTINO M.D.

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	208D00000X	General Practice Physician	MA07168000	NJ

General Provider Information

NPI Number	:	1669482568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN HERBERT FAUSTINO M.D.

Provider Business Mailing Address
First Line	:	1616 PACIFIC AVE
Second Line	:	SUITE 212
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-6939
Country	:	US
Telephone Number	:	609-498-7220
Fax Number	:	185-527-1739

Provider Business Practice Location Address
First Line	:	1616 PACIFIC AVE
Second Line	:	SUITE 212
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-6939
Country	:	US
Telephone Number	:	609-498-7220
Fax Number	:	185-527-1739

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	06/27/2011

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