Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 045537 | CT |
Y | 2080P0203X | Pediatric Critical Care Doctor | 045537 | CT |
NPI | 1053593400 |
---|---|
Provider Name | Dr. Edward Vincent Faustino |
First Address | New Haven, CT 06520-8064 |
Second Address | New Haven, CT 06520-8064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 18/06/2008 |