Healthcare Provider Details

I. General information

NPI: 1851754022
Provider Name (Legal Business Name): JARED M. GOLDFARB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 06/10/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ROUTE 33 SUITE 101
NEPTUNE NJ
07753-0775
US

IV. Provider business mailing address

3700 ROUTE 33 SUITE 101
NEPTUNE NJ
07753-2532
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-7855
  • Fax: 732-280-7815
Mailing address:
  • Phone: 732-280-7855
  • Fax: 732-280-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25MA11161000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA11161000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: