Active NPI
Thomas Facelle, MD
- Surgery Physician
- Suffern, NY
National Provider Identifier
1992801344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 145054
- Practice address
- 257 Lafayette Ave
Suite 200
Suffern, NY 10901-4830 - Phone
- (845) 369-8800
- Fax
- (845) 357-0086
- NPI assigned
- Sep 15, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 145054 | NY | Primary |
Addresses
Primary practice location
257 Lafayette Ave
Suite 200
Suffern, NY 10901-4830
Mailing address
20 Grand St
3Rd Floor
Warwick, NY 10990-1035
Phone (845) 987-3906
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 089D611 | Other | EMPIRE BLUE CROSS | |
| 08647 | Other | GHI HMO | |
| 0D3802 | Other | HEALTHNET NE | |
| 145054 | Other | HIP OF NY | |
| 4096594 | Other | AETNA TRADITIONAL | |
| RS363 | Other | OXFORD | |
| 0002459 | Other | GHI | |
| 01015883 | Medicaid | NY | |
| 0095911 | Other | AETNA HMO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 145054 | NY | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383782400000",
"number": "1992801344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 GRAND ST",
"address_2": "3RD FLOOR",
"city": "WARWICK",
"state": "NY",
"postal_code": "109901035",
"telephone_number": "845-987-3906",
"fax_number": "845-987-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "257 LAFAYETTE AVE",
"address_2": "SUITE 200",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109014830",
"telephone_number": "845-369-8800",
"fax_number": "845-357-0086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FACELLE",
"first_name": "THOMAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-15",
"last_updated": "2013-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "145054",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BLUE CROSS",
"identifier": "089D611",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI HMO",
"identifier": "08647",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET NE",
"identifier": "0D3802",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP OF NY",
"identifier": "145054",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA TRADITIONAL",
"identifier": "4096594",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "RS363",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0002459",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01015883",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "0095911",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Suffern, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.