Provider Demographics
NPI:1275635070
Name:FALTAS, ASHRAF
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:FALTAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:201-313-3222
Mailing Address - Fax:201-313-3220
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:201-313-3222
Practice Address - Fax:201-313-3220
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07315400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8672008Medicaid
NJ8672008Medicaid
H50124Medicare UPIN