1740389832 NPI number — DR. HOWARD SYD FADEN MD

Table of content: DR. HOWARD SYD FADEN MD (NPI 1740389832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740389832 NPI number — DR. HOWARD SYD FADEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FADEN
Provider First Name:
HOWARD
Provider Middle Name:
SYD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1740389832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4511 HARLEM RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-839-6720
Provider Business Mailing Address Fax Number:
716-839-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 BRYANT ST
Provider Second Line Business Practice Location Address:
INFECTIOUS DISEASE DIVISION
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14222-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-878-7312
Provider Business Practice Location Address Fax Number:
716-888-3804
Provider Enumeration Date:
09/22/2006

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: 2080P0208X , with the licence number:  127861 , 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: 00010052601 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3305785 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000507105001 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00697094 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0010996234001 . This is a "PA MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426000955 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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