Provider Demographics
NPI:1508952433
Name:MARK S GOLDFARB, MD, PA
Entity Type:Organization
Organization Name:MARK S GOLDFARB, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-488-2020
Mailing Address - Street 1:130 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1939
Mailing Address - Country:US
Mailing Address - Phone:201-488-2020
Mailing Address - Fax:201-488-1582
Practice Address - Street 1:130 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1939
Practice Address - Country:US
Practice Address - Phone:201-488-2020
Practice Address - Fax:201-488-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27921207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0435450001Medicare NSC
NJ052481Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER