Provider Demographics
NPI:1922064880
Name:FAIELLA, LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:FAIELLA
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 1:1305 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1657
Mailing Address - Country:US
Mailing Address - Phone:516-742-3200
Mailing Address - Fax:516-746-5847
Practice Address - Street 1:1305 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1657
Practice Address - Country:US
Practice Address - Phone:516-742-3200
Practice Address - Fax:516-746-5847
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196505208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41435Medicare UPIN