Provider Demographics
NPI:1316298656
Name:FAB LLC
Entity type:Organization
Organization Name:FAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:917-865-3482
Mailing Address - Street 1:4024 HUBBARD PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4953
Mailing Address - Country:US
Mailing Address - Phone:917-865-3482
Mailing Address - Fax:718-252-2596
Practice Address - Street 1:4024 HUBBARD PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4953
Practice Address - Country:US
Practice Address - Phone:917-865-3482
Practice Address - Fax:718-252-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LP2300X, 374U00000X, 376K00000X
NY1942590302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty