Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 180968 | NY |
NPI | 1003986456 |
---|---|
Provider Name | Dr. Glenn Rory Faust |
First Address | East Meadow, NY 11554-1859 |
Second Address | East Meadow, NY 11554-1859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 25/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01363560 | (05) | NY |
F37653 | (02) | NY |