Basic Information
| Provider Information | |||||||||
| NPI: | 1225323728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUIS G. FARES II, MD, FACS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 WASHINGTON CROSSING RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097372223 | ||||||||
| FaxNumber: | 6097372350 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 WASHINGTON CROSSING RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097372223 | ||||||||
| FaxNumber: | 6097372350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2011 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | FARES | ||||||||
| AuthorizedOfficialFirstName: | LOUIS | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6097372223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA03951500 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.