Provider Demographics
NPI:1447259122
Name:FACCONE, JOHN A (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:FACCONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6936
Mailing Address - Country:US
Mailing Address - Phone:908-964-6600
Mailing Address - Fax:908-364-1016
Practice Address - Street 1:900 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6936
Practice Address - Country:US
Practice Address - Phone:908-964-6600
Practice Address - Fax:908-936-4101
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB63614207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0599209OtherGHI
NJ7410124OtherAETNA
NJ8456607Medicaid
NJ0824982000OtherAMERIHEALTH
NJP2107734OtherOXFORD
NJ0824982000OtherAMERIHEALTH
NJH11299Medicare UPIN