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General NPI Number Information
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NPI Number | 1013648880
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Entity Type | Individual
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Provider Name | MAXWELL FARKAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 43 WESTMINSTER AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621-3913
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Country | US
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Telephone | 201-387-1957
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Fax |
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Provider Business Mailing Address
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Address Line | 126 AYERS CT APT 3B
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City | TEANECK
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State | NJ
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Zip | 07666-5127
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Country | US
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Telephone | 917-671-6742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00705500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 028306-01
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License Number State | NY
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