Healthcare Provider Details

I. General information

NPI: 1518528264
Provider Name (Legal Business Name): FAVORITE M GARFINKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CHARLES ST APT 3
HACKENSACK NJ
07601-3151
US

IV. Provider business mailing address

219 CHARLES ST APT 3
HACKENSACK NJ
07601-3151
US

V. Phone/Fax

Practice location:
  • Phone: 973-444-0879
  • Fax:
Mailing address:
  • Phone: 973-444-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01087500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier40QA01087500
Identifier TypeOTHER
Identifier StateNJ
Identifier Issuer40QA01087900

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: