Provider Demographics
NPI:1619991064
Name:FARNUM, ELISABETH K (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:K
Last Name:FARNUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS RD
Mailing Address - Street 2:BLDG 2, STE 220
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-696-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08497207Q00000X
NJ25MA09833800207Q00000X
VT042.0013369207Q00000X
FLME130791207Q00000X
GA077731207Q00000X
NY282381207Q00000X
MI4301108765207Q00000X
DEC1-0011547207Q00000X
MA265343207Q00000X
MDD80704207Q00000X
MEMD20824207Q00000X
PAMD456976207Q00000X
CT55110207Q00000X
IN01076690A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1671OtherNEIGHBORHOOD HEALTH
RI229977OtherBCBS
404222OtherTUFTS
RIEF01846Medicaid
0101201OtherUNITED HEALTHCARE
203459OtherBLUECHIP
NONHMO5270203OtherAETNA US HEALTHCARE
713736OtherHARVARD PILGRIM
HMO2287823OtherAETNA US HEALTHCARE
RI1671OtherNEIGHBORHOOD HEALTH
RIEF01846Medicaid