Provider Demographics
NPI:1154313955
Name:FARKAS, EDWARD LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEWIS
Last Name:FARKAS
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 1:175 CEDAR LN
Mailing Address - Street 2:STE A
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4315
Mailing Address - Country:US
Mailing Address - Phone:201-692-8354
Mailing Address - Fax:201-692-0234
Practice Address - Street 1:175 CEDAR LN
Practice Address - Street 2:STE A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4315
Practice Address - Country:US
Practice Address - Phone:201-692-8354
Practice Address - Fax:201-692-0234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA404102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B19236Medicare UPIN
FA449189Medicare ID - Type Unspecified