Basic Information
| Provider Information | |||||||||
| NPI: | 1225012685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAUBERT | ||||||||
| FirstName: | FENELON PIERRE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | I | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BROOKDALE PLZ | ||||||||
| Address2: | ROOM 169 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405615 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 BROOKDALE PLZ | ||||||||
| Address2: | ROOM 169 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405615 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 10/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 120537 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00433298 | 05 | NY | MEDICAID | 0833296004 | 01 | NY | CIGNA REGULAR | OTHER | 0833296005 | 01 | NY | CIGNA SENIORS | OTHER | 10986 | 01 | NY | ELDERPLAN | OTHER | KS438 | 01 | OXFORD | OTHER | 41A601 | 01 | NY | MEDICARE PTAN | OTHER | 120537 | 01 | NY | HIP | OTHER | 13-65326 | 01 | NY | UNITED HEALTHCARE | OTHER | 2503983 | 01 | NY | GHI | OTHER |