MEDICARE: DR. FREDERICK F FAKHARZADEH M.D.

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	207XS0106X	Orthopaedic Hand Surgery Physician	25MA04750600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497790067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK F FAKHARZADEH M.D.

Provider Business Mailing Address
First Line	:	22 MADISON AVE
Second Line	:	3RD FLOOR
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2734
Country	:	US
Telephone Number	:	201-587-7767
Fax Number	:	201-587-8090

Provider Business Practice Location Address
First Line	:	22 MADISON AVE
Second Line	:	3RD FLOOR
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2734
Country	:	US
Telephone Number	:	201-587-7767
Fax Number	:	201-587-8090

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/24/2011

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