Healthcare Provider Details

I. General information

NPI: 1659464402
Provider Name (Legal Business Name): JORGE ADALBERTO FARRAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 EASY ST
DUNN NC
28334-7988
US

IV. Provider business mailing address

2800 MARCUS AVE
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 910-567-6194
  • Fax: 910-567-4389
Mailing address:
  • Phone: 516-622-6000
  • Fax: 516-622-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201201998
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: