Provider Demographics
NPI:1417180027
Name:FARACI, LINDSEY NICOLE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:NICOLE
Last Name:FARACI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 OCEAN HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3534
Mailing Address - Country:US
Mailing Address - Phone:516-448-6322
Mailing Address - Fax:
Practice Address - Street 1:34 W 27TH ST
Practice Address - Street 2:SUITE 1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6907
Practice Address - Country:US
Practice Address - Phone:212-757-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013361208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine