Healthcare Provider Details

I. General information

NPI: 1467636936
Provider Name (Legal Business Name): CATHEDRAL FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 DR. MARTIN LUTHER KING BOULEVARD
NEWARK NJ
07102-2094
US

IV. Provider business mailing address

66 W GILBERT ST 2ND FLOOR
RED BANK NJ
07701-4819
US

V. Phone/Fax

Practice location:
  • Phone: 973-877-5000
  • Fax:
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. IRVIN GOLDFARB
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 973-877-5000