Provider Demographics
NPI:1376759100
Name:FAROOQ, TAHIR (MD)
Entity Type:Individual
Prefix:
First Name:TAHIR
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3831
Mailing Address - Country:US
Mailing Address - Phone:609-581-2000
Mailing Address - Fax:609-581-5450
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 411
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3831
Practice Address - Country:US
Practice Address - Phone:609-581-2000
Practice Address - Fax:609-581-5450
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08239100207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138878Medicaid
NJ440002476OtherRAILROAD MEDICARE
NJ25MA08239100OtherMEDICAL LICENSE
NJ0138878Medicaid