Provider Demographics
NPI:1720062227
Name:GOLDFARB, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GOLDFARB
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 1:2130 MILLBURN AVE
Mailing Address - Street 2:SUITE C6
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3725
Mailing Address - Country:US
Mailing Address - Phone:973-762-8200
Mailing Address - Fax:973-762-8203
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:C6
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:973-762-8200
Practice Address - Fax:973-762-8203
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03861200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4094729OtherAETNA
NJ443321OtherCIGNA
NJP1550250OtherOXFORD
NJ0203505Medicaid
NJ276566OtherUNITED HEALTH CARE
NJ636266OtherFIRST HEALTH
NJF03666OtherHEALTHNET
NJC52870Medicare UPIN
NJ0203505Medicaid