MEDICARE: IWAMAYE AND FARBER MD PA

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1447464219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IWAMAYE AND FARBER MD PA

Provider Business Mailing Address
First Line	:	565 HWY 35
Second Line	:	SUITE 4
City	:	RED BANK
State	:	NJ
Zip	:	07701-5047
Country	:	US
Telephone Number	:	732-741-1485
Fax Number	:	732-345-0164

Provider Business Practice Location Address
First Line	:	565 HWY 35
Second Line	:	SUITE 4
City	:	RED BANK
State	:	NJ
Zip	:	07701-5047
Country	:	US
Telephone Number	:	732-741-1485
Fax Number	:	732-345-0164

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HIROSHI IWAMAYE
Credential	:	MD
Telephone Number	:	732-741-1485

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	10/12/2010

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