1326003914 NPI number — DR. MICHAEL L FARRELL DO

Table of content: DR. MICHAEL L FARRELL DO (NPI 1326003914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326003914 NPI number — DR. MICHAEL L FARRELL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELL
Provider First Name:
MICHAEL
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1326003914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER SADDLE RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-790-9301
Provider Business Mailing Address Fax Number:
201-785-9609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
547 UNION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOTOWA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-790-9301
Provider Business Practice Location Address Fax Number:
201-785-9609
Provider Enumeration Date:
04/18/2006

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: 208600000X , with the licence number:  M868138 , 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: 00203882 . This is a "PALMETTO RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7863053 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91001477700 . This is a "AMERICHOICE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1941041 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: J12009 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8090301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1108753 . This is a "NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54231 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".




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