Provider Demographics
NPI:1881874642
Name:WEST, FAY (MD)
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:
Last Name:WEST
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 1:36 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-1104
Mailing Address - Country:US
Mailing Address - Phone:210-414-2678
Mailing Address - Fax:
Practice Address - Street 1:40 SUNSHINE COTTAGE RD, SKYLINE BLDG, #1N-J14
Practice Address - Street 2:NEW YORK MEDICAL COLLEGE DEPT PEDS HEME ONC
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:210-414-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277739207ZP0102X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06550070Medicaid
COCO305414Medicare PIN