Healthcare Provider Details

I. General information

NPI: 1699479550
Provider Name (Legal Business Name): RUBAB FAROOQ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date: 07/01/2026
Reactivation Date: 07/23/2026

III. Provider practice location address

1899 ROUTE 88
BRICK NJ
08724-3124
US

IV. Provider business mailing address

1899 ROUTE 88
BRICK NJ
08724-3124
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-8177
  • Fax:
Mailing address:
  • Phone: 732-840-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA12984100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: