Provider Demographics
NPI:1669567640
Name:FAYER, STEVEN ALAN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:FAYER
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 1:169 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3222
Mailing Address - Country:US
Mailing Address - Phone:212-628-6208
Mailing Address - Fax:212-249-2454
Practice Address - Street 1:161 E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-628-6208
Practice Address - Fax:212-249-2454
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120502084S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12285Medicare UPIN
289511Medicare ID - Type Unspecified