Provider Demographics
NPI:1245577758
Name:JEFFREY FARNESE MD LLC
Entity Type:Organization
Organization Name:JEFFREY FARNESE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARNESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-890-0330
Mailing Address - Street 1:109 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1107
Mailing Address - Country:US
Mailing Address - Phone:973-890-0330
Mailing Address - Fax:973-890-0705
Practice Address - Street 1:109 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1107
Practice Address - Country:US
Practice Address - Phone:973-890-0330
Practice Address - Fax:973-890-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06944400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty