Provider Demographics
NPI:1700833449
Name:PADDER, FAROOQ A (MD)
Entity Type:Individual
Prefix:
First Name:FAROOQ
Middle Name:A
Last Name:PADDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W RED BANK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-845-6807
Mailing Address - Fax:856-845-3760
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-845-6807
Practice Address - Fax:856-845-3760
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06678600207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7566147OtherAETNA
NJP3196551OtherOXFORD
PA2140867000OtherBLUE SHIELD PENNSYLVANIA
NJ222173875OtherBLUE SHIELD NEW JERSEY
NJ2642963003OtherCIGNA
NJ3371914OtherAETNA US HEALTHCARE
NJ2140867000OtherAMERIHEALTH
NJ8257205Medicaid
NJP3196551OtherOXFORD
NJ7566147OtherAETNA
NJ222173875OtherBLUE SHIELD NEW JERSEY