Provider Demographics
NPI:1326320235
Name:FARBOWITZ, AVIVA
Entity Type:Individual
Prefix:MRS
First Name:AVIVA
Middle Name:
Last Name:FARBOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 W LAURELTON PKWY
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2751
Mailing Address - Country:US
Mailing Address - Phone:917-613-2336
Mailing Address - Fax:
Practice Address - Street 1:406 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4312
Practice Address - Country:US
Practice Address - Phone:201-384-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03381400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist