Provider Demographics
NPI:1679581524
Name:SHAFAIE, FARROKH (MD)
Entity Type:Individual
Prefix:
First Name:FARROKH
Middle Name:
Last Name:SHAFAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 OVERLOOK ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3563
Mailing Address - Country:US
Mailing Address - Phone:908-522-1777
Mailing Address - Fax:908-522-3051
Practice Address - Street 1:33 OVERLOOK ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3563
Practice Address - Country:US
Practice Address - Phone:908-522-1777
Practice Address - Fax:908-522-3051
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03675000208200000X
NY1452731208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08586Medicare UPIN
SH542780Medicare ID - Type Unspecified