Provider Demographics
NPI:1578832242
Name:FARES DIARBAKERLI MD PC
Entity Type:Organization
Organization Name:FARES DIARBAKERLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIARBAKERLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-571-6939
Mailing Address - Street 1:716 BROAD ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1645
Mailing Address - Country:US
Mailing Address - Phone:862-571-6939
Mailing Address - Fax:973-574-1008
Practice Address - Street 1:716 BROAD ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1645
Practice Address - Country:US
Practice Address - Phone:862-571-6939
Practice Address - Fax:973-574-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08580900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty