Provider Demographics
NPI:1679534176
Name:FARRELL, PAUL ROBERT (M D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:FARRELL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2410
Mailing Address - Country:US
Mailing Address - Phone:732-974-8292
Mailing Address - Fax:732-974-1551
Practice Address - Street 1:2640 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2609
Practice Address - Country:US
Practice Address - Phone:732-528-8448
Practice Address - Fax:732-223-5792
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03203500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF-0853704Medicaid