Healthcare Provider Details

I. General information

NPI: 1114902848
Provider Name (Legal Business Name): PERRY G FARB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MONARCH PL 10TH FLOOR
SPRINGFIELD MA
01144-1099
US

IV. Provider business mailing address

1 MONARCH PL 10TH FLOOR
SPRINGFIELD MA
01144-1099
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-2000
  • Fax: 413-734-8000
Mailing address:
  • Phone: 413-734-2000
  • Fax: 413-734-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number224137
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: