1205924248 NPI number — DR. JOHN J FARKAS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205924248 NPI number — DR. JOHN J FARKAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARKAS
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205924248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 MCBRIDE AVE FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07424-3806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-785-2277
Provider Business Mailing Address Fax Number:
973-785-2355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
842 CLIFTON AVE STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07013-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-777-5717
Provider Business Practice Location Address Fax Number:
201-632-4815
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MA48276 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0554214 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5V9731 . This is a "BC BS OF NY 716 BROAD ST." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0115607000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1694804 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3K8631 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 398180 . This is a "WELLCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5V9732 . This is a "BC BS OF NJ SUITE 102 W. PATERSON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3929819 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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