Provider Demographics
NPI:1134373327
Name:FARESICH PARTNER PROCESS, LLC
Entity type:Organization
Organization Name:FARESICH PARTNER PROCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARESICH
Authorized Official - Suffix:
Authorized Official - Credentials:APNC
Authorized Official - Phone:973-219-7800
Mailing Address - Street 1:4 MEADOW LARK CT
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2128
Mailing Address - Country:US
Mailing Address - Phone:973-361-8113
Mailing Address - Fax:
Practice Address - Street 1:311 SOUTH LIVINGSTON AVENUE
Practice Address - Street 2:INGLEMOOR REHABILITATION AND CARE CENTER
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-994-0221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08294900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0007595Medicaid
052935Medicare PIN