Provider Demographics
NPI:1750580726
Name:FANI, PAULINE (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:
Last Name:FANI
Suffix:
Gender:F
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:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-0013
Mailing Address - Country:US
Mailing Address - Phone:516-699-7790
Mailing Address - Fax:516-870-5770
Practice Address - Street 1:9 CENTER DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1447
Practice Address - Country:US
Practice Address - Phone:516-699-7790
Practice Address - Fax:516-870-5770
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2302182080P0201X, 2080P0214X, 207KA0200X, 2080P0201X, 2080P0214X
CAA94837208000000X, 2080P0201X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics