Healthcare Provider Details

I. General information

NPI: 1831373083
Provider Name (Legal Business Name): FARRAH ALTUVE PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S MAPLE AVE
RIDGEWOOD NJ
07450-4561
US

IV. Provider business mailing address

800 SPRUCE ST 1 CATHCART
PHILADELPHIA PA
19107-6130
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2830
  • Fax: 215-829-2477
Mailing address:
  • Phone: 215-829-2222
  • Fax: 215-829-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00201200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: