Provider Demographics
NPI:1609976984
Name:FARAG, DAVID (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FARAG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:182 SOUTH STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5350
Mailing Address - Country:US
Mailing Address - Phone:973-936-1802
Mailing Address - Fax:973-695-1480
Practice Address - Street 1:182 SOUTH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5350
Practice Address - Country:US
Practice Address - Phone:973-936-1802
Practice Address - Fax:973-695-1480
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00137100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ43706Medicare UPIN
NJ090992WJ8Medicare PIN
NJQ43706Medicare UPIN