Organization Name: | JOHN A. FACCHIN, O.D. |
NPI Number: | 1871776450 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN A. FACCHIN (SOLE PROPRIETOR) |
Mailing Address: | 111 Grand Ave Massapequa |
State: | NY US |
Postal Code: | 117584905 |
Phone Number: | 5167982635 |
Fax Number: | |
NPI Enumeration Date: | 12/06/2007 |
NPI Last Update Date: | 11/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 0978400001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |