Provider Demographics
NPI:1770559064
Name:RAFIZADEH, FARHAD (MD)
Entity type:Individual
Prefix:
First Name:FARHAD
Middle Name:
Last Name:RAFIZADEH
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 1:101 MADISON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7357
Mailing Address - Country:US
Mailing Address - Phone:973-267-0928
Mailing Address - Fax:973-267-6960
Practice Address - Street 1:101 MADISON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7357
Practice Address - Country:US
Practice Address - Phone:973-267-0928
Practice Address - Fax:973-267-6960
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03770300208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53533Medicare UPIN
NJ143733Medicare PIN