Provider Demographics
NPI:1396833760
Name:GOLDFARB, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LOUIS ST
Mailing Address - Street 2:PO BOX 628
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2104
Mailing Address - Country:US
Mailing Address - Phone:732-969-3480
Mailing Address - Fax:732-969-9591
Practice Address - Street 1:1 LOUIS ST
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2104
Practice Address - Country:US
Practice Address - Phone:732-969-3480
Practice Address - Fax:732-969-9591
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00254200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG0439518Medicare ID - Type Unspecified