Provider Demographics
NPI:1225323728
Name:LOUIS G. FARES II, MD, FACS, LLC
Entity Type:Organization
Organization Name:LOUIS G. FARES II, MD, FACS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARES
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:609-737-2223
Mailing Address - Street 1:116 WASHINGTON CROSSING RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2514
Mailing Address - Country:US
Mailing Address - Phone:609-737-2223
Mailing Address - Fax:609-737-2350
Practice Address - Street 1:116 WASHINGTON CROSSING RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2514
Practice Address - Country:US
Practice Address - Phone:609-737-2223
Practice Address - Fax:609-737-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03951500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty