Provider Demographics
NPI:1922057538
Name:IDJADI, FARHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:IDJADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FARHAD
Other - Middle Name:
Other - Last Name:IDJADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1644 ROUTE 565
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4490
Mailing Address - Country:US
Mailing Address - Phone:201-280-3646
Mailing Address - Fax:
Practice Address - Street 1:1644 ROUTE 565
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07461-4490
Practice Address - Country:US
Practice Address - Phone:973-875-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02473600208600000X
PAMD030612E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022558610001Medicaid
PA823755OtherFIRST PRIORITY HEALTH
PA174468OtherHIGHMARK BLUE SHIELD
PA174468OtherHIGHMARK BLUE SHIELD
PA1022558610001Medicaid