Active NPI
Philip Louis Fava II, D.M.D.
- Student in an Organized Health Care Education/Training Program
- Farmington, CT
National Provider Identifier
1851603419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 263 Farmington Ave
Farmington, CT 06030-0001 - Phone
- (860) 679-2000
- NPI assigned
- Jul 11, 2010
- Last updated
- Jul 11, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | Primary |
Addresses
Primary practice location
263 Farmington Ave
Farmington, CT 06030-0001
Mailing address
222 Castlewood Dr
Bloomfield, CT 06002-1370
Phone (631) 875-0922
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150504000158 | PA | Order and Referring Only - Other (Physician) | 6406175082 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278806400000",
"number": "1851603419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 CASTLEWOOD DR",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060021370",
"telephone_number": "631-875-0922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "263 FARMINGTON AVE",
"city": "FARMINGTON",
"state": "CT",
"postal_code": "060300001",
"telephone_number": "860-679-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAVA",
"first_name": "PHILIP",
"middle_name": "LOUIS",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-11",
"last_updated": "2010-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.