Provider Demographics
NPI:1497790067
Name:FAKHARZADEH, FREDERICK F (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:F
Last Name:FAKHARZADEH
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 1:22 MADISON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2734
Mailing Address - Country:US
Mailing Address - Phone:201-587-7767
Mailing Address - Fax:201-587-8090
Practice Address - Street 1:22 MADISON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2734
Practice Address - Country:US
Practice Address - Phone:201-587-7767
Practice Address - Fax:201-587-8090
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04750600207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1383701Medicaid
NJ1383701Medicaid