Provider Demographics
NPI:1811548142
Name:ERIC FANAEE MD PC
Entity Type:Organization
Organization Name:ERIC FANAEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FANAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-5371
Mailing Address - Street 1:380 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4403
Mailing Address - Country:US
Mailing Address - Phone:631-422-5371
Mailing Address - Fax:631-893-8012
Practice Address - Street 1:380 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4403
Practice Address - Country:US
Practice Address - Phone:631-422-5371
Practice Address - Fax:631-893-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty