Provider Demographics
NPI:1326003914
Name:FARRELL, MICHAEL L (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458
Mailing Address - Country:US
Mailing Address - Phone:973-790-9301
Mailing Address - Fax:201-785-9609
Practice Address - Street 1:547 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512
Practice Address - Country:US
Practice Address - Phone:973-790-9301
Practice Address - Fax:201-785-9609
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM868138208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00203882OtherPALMETTO RR MEDICARE
7863053OtherAETNA
91001477700OtherAMERICHOICE MEDICAID
1941041OtherOXFORD
J12009OtherHEALTHNET
NJ8090301Medicaid
1108753OtherNJ HEALTH
54231OtherAMERIGROUP
00203882OtherPALMETTO RR MEDICARE
H08482Medicare UPIN