Provider Demographics
NPI:1912145608
Name:ELLIOTT FARBERMAN M.D.,P.C.
Entity Type:Organization
Organization Name:ELLIOTT FARBERMAN M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FARBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-921-7509
Mailing Address - Street 1:1224 GRAHAM RD
Mailing Address - Street 2:2005
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-921-7509
Mailing Address - Fax:314-921-8205
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:SUITE 2005
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-921-7509
Practice Address - Fax:314-921-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5711208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty