Provider Demographics
NPI:1881646552
Name:FARRIS, EDMUND PAUL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:PAUL
Last Name:FARRIS
Suffix:JR
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 1:179 SPRAIN RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:914-693-6668
Practice Address - Street 1:24 SAW MILL RIVER RD STE 202
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1555
Practice Address - Country:US
Practice Address - Phone:914-345-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193564207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01728289Medicaid
NY01728289Medicaid
86T321Medicare ID - Type Unspecified