Healthcare Provider Details

I. General information

NPI: 1447464219
Provider Name (Legal Business Name): IWAMAYE AND FARBER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 HWY 35 SUITE 4
RED BANK NJ
07701-5047
US

IV. Provider business mailing address

565 HWY 35 SUITE 4
RED BANK NJ
07701-5047
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-1485
  • Fax: 732-345-0164
Mailing address:
  • Phone: 732-741-1485
  • Fax: 732-345-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: HIROSHI IWAMAYE
Title or Position: PRESIDENT
Credential: MD
Phone: 732-741-1485