Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MA08995800 | NJ |
NPI | 1275892812 |
---|---|
Provider Name | Revital Faro |
First Address | New Brunswick, NJ 08901-1962 |
Second Address | New Brunswick, NJ 08901-1962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 15/05/2012 |