1821110263 NPI number — DR. FAYE ELIZABETH JUSTICIA-LINDE MD

Table of content: DR. FAYE ELIZABETH JUSTICIA-LINDE MD (NPI 1821110263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821110263 NPI number — DR. FAYE ELIZABETH JUSTICIA-LINDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUSTICIA-LINDE
Provider First Name:
FAYE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821110263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 MAIN ST FL 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14203-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-323-0715
Provider Business Mailing Address Fax Number:
716-323-0594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 MAIN ST FL 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-636-8284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  253828 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03124307 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".