Provider Demographics
NPI:1275780561
Name:MICHAEL GOLDFARB,M.D. P.A.
Entity Type:Organization
Organization Name:MICHAEL GOLDFARB,M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-762-8200
Mailing Address - Street 1:2130 MILLBURN AVE
Mailing Address - Street 2:SUITE C6
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3725
Mailing Address - Country:US
Mailing Address - Phone:973-762-8200
Mailing Address - Fax:973-762-8203
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:SUITE C6
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:973-762-8200
Practice Address - Fax:973-762-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0203505Medicaid
NJ=========OtherBLUECROSS/BLUESHIELD
NJ059440Medicare PIN
NJ0203505Medicaid