Provider Demographics
NPI:1720827892
Name:FAUSTIN, SAMUEL (PT,DPT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:FAUSTIN
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BEACH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-5202
Mailing Address - Country:US
Mailing Address - Phone:516-410-1324
Mailing Address - Fax:
Practice Address - Street 1:616 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3619
Practice Address - Country:US
Practice Address - Phone:516-586-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist