Provider Demographics
NPI:1952477663
Name:FARZAD, SHAPAR M (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SHAPAR
Middle Name:M
Last Name:FARZAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 PENNINGTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534
Mailing Address - Country:US
Mailing Address - Phone:609-818-9080
Mailing Address - Fax:609-737-7032
Practice Address - Street 1:2480 PENNINGTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-818-9080
Practice Address - Fax:609-737-7032
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ355100372800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
028896Medicare UPIN
NJ028896Medicare ID - Type Unspecified