MEDICARE: REBECCA FAICCO PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	23-013506	NY

General Provider Information

NPI Number	:	1720313414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA FAICCO PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	500 RAFT AVE
Second Line	:
City	:	HOLBROOK
State	:	NY
Zip	:	11741-5912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 MIDDLE COUNTRY RD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-2516
Country	:	US
Telephone Number	:	631-696-5437
Fax Number	:

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

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	05/04/2026

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