Provider Demographics
NPI:1770770513
Name:AHMAD FARZAD MD PA
Entity type:Organization
Organization Name:AHMAD FARZAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZAD MD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-737-7555
Mailing Address - Street 1:2480 PENNINGTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-5227
Mailing Address - Country:US
Mailing Address - Phone:609-737-7555
Mailing Address - Fax:607-737-7032
Practice Address - Street 1:2480 PENNINGTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5227
Practice Address - Country:US
Practice Address - Phone:609-737-7555
Practice Address - Fax:607-737-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ028512Medicare PIN