Provider Demographics
NPI:1225012685
Name:FAUBERT, FENELON PIERRE I (MD)
Entity Type:Individual
Prefix:
First Name:FENELON PIERRE
Middle Name:
Last Name:FAUBERT
Suffix:I
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 1:1 BROOKDALE PLZ
Mailing Address - Street 2:ROOM 169
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-5615
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:ROOM 169
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120537207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00433298Medicaid
NY0833296004OtherCIGNA REGULAR
NY0833296005OtherCIGNA SENIORS
NY10986OtherELDERPLAN
KS438OtherOXFORD
NY41A601OtherMEDICARE PTAN
NY120537OtherHIP
NY13-65326OtherUNITED HEALTHCARE
NY2503983OtherGHI