Provider Demographics
NPI:1255495792
Name:CEUS, FAIDHERBE (MD)
Entity Type:Individual
Prefix:DR
First Name:FAIDHERBE
Middle Name:
Last Name:CEUS
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 1:60 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3010
Mailing Address - Country:US
Mailing Address - Phone:845-623-3120
Mailing Address - Fax:845-623-8998
Practice Address - Street 1:60 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3010
Practice Address - Country:US
Practice Address - Phone:845-623-3120
Practice Address - Fax:845-623-8998
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197802175L00000X
MI43010896162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4997641Medicaid