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NPI Code Detail

MEDICARE: MARTHA J FAREWELL

MEDICARE: MARTHA J FAREWELL
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
1235Z00000XSpeech-Language Pathologist7047-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100025214901OTHERNYUNIVERA
29390329OTHERNYINDEPENDENT HEALTH

General Provider Information

NPI Number : 1477575629
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA J FAREWELL
Provider Business Mailing Address
First Line : 1773 EGGERT RD
Second Line :
City : AMHERST
State : NY
Zip : 14226-2352
Country : US
Telephone Number : 716-832-9626
Fax Number :
Provider Business Practice Location Address
First Line : 7 COMMUNITY DR
Second Line :
City : BUFFALO
State : NY
Zip : 14225-2523
Country : US
Telephone Number : 716-505-5634
Fax Number : 716-892-1936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 07/09/2007

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Directions to “ MARTHA J FAREWELL ” Practice Location

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