Provider Demographics
NPI:1962406595
Name:FAUST, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FAUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 N FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1139
Mailing Address - Country:US
Mailing Address - Phone:201-236-2100
Mailing Address - Fax:201-236-5269
Practice Address - Street 1:581 N FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1139
Practice Address - Country:US
Practice Address - Phone:201-236-2100
Practice Address - Fax:201-236-5269
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05023100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP404874OtherOXFORD ID #
NJ14E493OtherEMPIRE BC/BS (RAMSEY)
NJ14E492OtherEMPIRE BC/BS (MIDLAND PK)
NJ0K5801OtherHEALTHNET ID #
NJ4201262OtherAETNA PPO ID #
NJ160046094OtherRAILROAD MDCR #
NJ4201262OtherAETNA PPO ID #
NJ413435C7CMedicare PIN