Provider Demographics
NPI:1669482568
Name:FAUSTINO, ALAN HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:HERBERT
Last Name:FAUSTINO
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 1:1616 PACIFIC AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6939
Mailing Address - Country:US
Mailing Address - Phone:609-498-7220
Mailing Address - Fax:185-527-1739
Practice Address - Street 1:1616 PACIFIC AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6939
Practice Address - Country:US
Practice Address - Phone:609-498-7220
Practice Address - Fax:185-527-1739
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07168000208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG79005Medicare UPIN