MEDICARE: DR. FARKHANDA IZHAR FAROOQI DNP AGPCNP- BC PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	26NJ00841200	NJ
2	363LP2300X	Primary Care Nurse Practitioner	308691	NY

General Provider Information

NPI Number	:	1295226322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARKHANDA IZHAR FAROOQI DNP AGPCNP- BC PMHNP

Provider Business Mailing Address
First Line	:	477 MINE BROOK RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2007
Country	:	US
Telephone Number	:	201-744-1391
Fax Number	:	908-502-5791

Provider Business Practice Location Address
First Line	:	477 MINE BROOK RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2007
Country	:	US
Telephone Number	:	201-744-1391
Fax Number	:	908-502-5791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2018
Last Update Date	:	04/23/2024

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