Healthcare Provider Details

I. General information

NPI: 1902657067
Provider Name (Legal Business Name): ALLAN FARKAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

IV. Provider business mailing address

2675 EDGEWOOD RD
BEACHWOOD OH
44122-1570
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-4010
  • Fax:
Mailing address:
  • Phone: 201-981-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number441159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: