Provider Demographics
NPI:1629684410
Name:RAHMAN, FAR (ND, MSC)
Entity Type:Individual
Prefix:DR
First Name:FAR
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:ND, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4130
Mailing Address - Country:US
Mailing Address - Phone:917-940-6435
Mailing Address - Fax:
Practice Address - Street 1:386 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-5443
Practice Address - Country:US
Practice Address - Phone:917-940-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133N00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist