Healthcare Provider Details

I. General information

NPI: 1063708436
Provider Name (Legal Business Name): FARREL KEITH SILVERMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NEW RD STE 150A
LINWOOD NJ
08221-1100
US

IV. Provider business mailing address

1 MEDICAL CENTER DR UMDNJ-SOM
STRATFORD NJ
08084-1500
US

V. Phone/Fax

Practice location:
  • Phone: 609-788-3338
  • Fax: 609-788-3348
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB09425700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: