Provider Demographics
NPI:1689627192
Name:FAIVUS, HARRY E
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:E
Last Name:FAIVUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 86TH ST
Mailing Address - Street 2:APT 9SW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3121
Mailing Address - Country:US
Mailing Address - Phone:212-722-6951
Mailing Address - Fax:
Practice Address - Street 1:308 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3121
Practice Address - Country:US
Practice Address - Phone:212-722-6951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123797207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9255GGMedicare ID - Type Unspecified
NYB13253Medicare UPIN