Provider Demographics
NPI:1578578993
Name:MORKOS, FATEN FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:FATEN
Middle Name:FARID
Last Name:MORKOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1935
Mailing Address - Country:US
Mailing Address - Phone:973-661-5170
Mailing Address - Fax:
Practice Address - Street 1:741 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:973-483-3787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08120700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0108863Medicaid
NJ19727784113Other1150 SPRINGFIELD AVENUE
NJ1235300799Other37 N DAY
NJ1932370483Other101 LUDLOW
NJ1194996645Other444 WILLIAM STREET
NJ1740345693Other741 BROADWAY
NJ1932370483Other101 LUDLOW