Provider Demographics
NPI:1144607144
Name:FARISH-WILLIFORD, MARY HANNAH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY HANNAH
Middle Name:
Last Name:FARISH-WILLIFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-624-1877
Mailing Address - Fax:201-624-1879
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-624-1877
Practice Address - Fax:201-624-1879
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical