=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528331022
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YVONNE FARNACIO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2012
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 742 ROUTE 1 N
-----------------------------------------------------
City | ISELIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08830-2652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-362-3871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 ROSS HALL BLVD S
-----------------------------------------------------
City | PISCATAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08854-5815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-982-0074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | 25MA09532900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------