Provider Demographics
NPI:1093801920
Name:GOLDFARB, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1939
Mailing Address - Country:US
Mailing Address - Phone:201-488-2020
Mailing Address - Fax:201-488-1582
Practice Address - Street 1:130 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1939
Practice Address - Country:US
Practice Address - Phone:201-488-2020
Practice Address - Fax:201-488-1582
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27921207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOXFORDOtherBS085
NJ0599603Medicaid
NJAMERIHEALTHOther0076115000
NJHEALTHNETOtherOK1123
NJUNITED HEALTHCARE RROther180045910
NJHEALTHNETOtherOK1123
NJUNITED HEALTHCARE RROther180045910
NJ0599603Medicaid