Healthcare Provider Details

I. General information

NPI: 1508388794
Provider Name (Legal Business Name): FARHAD FOROUDI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S MAIN RD
VINELAND NJ
08360-7828
US

IV. Provider business mailing address

150 S MAIN RD
VINELAND NJ
08360-7828
US

V. Phone/Fax

Practice location:
  • Phone: 215-247-0879
  • Fax:
Mailing address:
  • Phone: 832-755-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00354800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: