Provider Demographics
NPI:1700948221
Name:FAUCI, PETER ANTHONY JR (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:FAUCI
Suffix:JR
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 1:23 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5504
Mailing Address - Country:US
Mailing Address - Phone:914-235-6540
Mailing Address - Fax:914-235-5209
Practice Address - Street 1:23 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5504
Practice Address - Country:US
Practice Address - Phone:914-235-6540
Practice Address - Fax:914-235-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081972174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA61710Medicare UPIN