Healthcare Provider Details

I. General information

NPI: 1629684410
Provider Name (Legal Business Name): FAR RAHMAN ND, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 MYRTLE AVE
BRIDGEPORT CT
06604-5443
US

IV. Provider business mailing address

48 CHESTER AVE
NEWARK NJ
07104-4130
US

V. Phone/Fax

Practice location:
  • Phone: 917-940-6435
  • Fax:
Mailing address:
  • Phone: 917-940-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: