1114267929 NPI number — JEFFREY FARKAS MD LLC

Table of content: (NPI 1114267929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114267929 NPI number — JEFFREY FARKAS MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY FARKAS MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114267929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 WESTMINSTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERGENFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07621-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-387-1957
Provider Business Mailing Address Fax Number:
201-351-0656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
EAST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11548-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-466-1029
Provider Business Practice Location Address Fax Number:
201-351-4065
Provider Enumeration Date:
02/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FARKAS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-387-1957

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  192230 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03563191 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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