Healthcare Provider Details

I. General information

NPI: 1770751513
Provider Name (Legal Business Name): FARID ABDUL-NOOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FARID A NOOR M.D.

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 NEWARK AVE SUITE 324
BELLEVILLE NJ
07109-4119
US

IV. Provider business mailing address

36 NEWARK AVE SUITE 324
BELLEVILLE NJ
07109-4119
US

V. Phone/Fax

Practice location:
  • Phone: 973-751-2060
  • Fax:
Mailing address:
  • Phone: 973-751-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49694
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: