=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447464219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IWAMAYE AND FARBER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 10/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 HWY 35 SUITE 4
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-741-1485
-----------------------------------------------------
Fax | 732-345-0164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 HWY 35 SUITE 4
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-741-1485
-----------------------------------------------------
Fax | 732-345-0164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HIROSHI IWAMAYE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-741-1485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------