Provider Demographics
NPI:1902368707
Name:FAROOQ, KHADIJA (DO)
Entity Type:Individual
Prefix:MRS
First Name:KHADIJA
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FLEET ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5030
Mailing Address - Country:US
Mailing Address - Phone:219-487-4215
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL PLZ STE 200
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3084
Practice Address - Country:US
Practice Address - Phone:732-360-4085
Practice Address - Fax:732-360-4086
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11556500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine