Healthcare Provider Details

I. General information

NPI: 1114267929
Provider Name (Legal Business Name): JEFFREY FARKAS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NORTHERN BLVD SUITE 207
EAST HILLS NY
11548-1220
US

IV. Provider business mailing address

43 WESTMINSTER AVE
BERGENFIELD NJ
07621-3913
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-1029
  • Fax: 201-351-4065
Mailing address:
  • Phone: 201-387-1957
  • Fax: 201-351-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number192230
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY FARKAS
Title or Position: PRESIDENT
Credential: MD
Phone: 201-387-1957