Provider Demographics
NPI:1720112097
Name:FAUSTINO, DWIGHT BENEDICT
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:BENEDICT
Last Name:FAUSTINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2841
Mailing Address - Country:US
Mailing Address - Phone:201-660-2484
Mailing Address - Fax:
Practice Address - Street 1:11 CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2841
Practice Address - Country:US
Practice Address - Phone:201-660-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01201000171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor