Provider Demographics
NPI:1235109158
Name:UNION COUNTY INFECTIOUS DISEASES GROUP
Entity Type:Organization
Organization Name:UNION COUNTY INFECTIOUS DISEASES GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-517-1257
Mailing Address - Street 1:240 WILLIAMSON ST STE 401
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3672
Mailing Address - Country:US
Mailing Address - Phone:908-282-0500
Mailing Address - Fax:908-282-1482
Practice Address - Street 1:240 WILLIAMSON ST STE 401
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3672
Practice Address - Country:US
Practice Address - Phone:908-282-0500
Practice Address - Fax:908-282-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7732805Medicaid
702772Medicare ID - Type Unspecified