Provider Demographics
NPI:1003945080
Name:FAUST, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FAUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 MADISON AVE RM 804
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0709
Mailing Address - Country:US
Mailing Address - Phone:212-986-3330
Mailing Address - Fax:212-953-1948
Practice Address - Street 1:274 MADISON AVE RM 804
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0709
Practice Address - Country:US
Practice Address - Phone:212-986-3330
Practice Address - Fax:212-953-1948
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139009207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0M0281OtherHEALTHNET
NYNS007OtherOXFORD
NYEMPIREOther86A30
NY0M0281OtherHEALTHNET
NYEMPIREOther86A30