Provider Demographics
NPI:1093776916
Name:GOLDFARB, SIDNEY JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:JACOB
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:STE 206
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-921-3008
Mailing Address - Fax:609-921-7533
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:STE 206
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-921-3008
Practice Address - Fax:609-921-7533
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37249208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0548901Medicaid
E60701Medicare UPIN
E60701Medicare UPIN