Healthcare Provider Details

I. General information

NPI: 1669769741
Provider Name (Legal Business Name): KANWAL MAJEED FAROOQI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST DIVISION OF PEDIATRIC CARDIOLOGY
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

90 BERGEN ST
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number258671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: