Basic Information
| Provider Information | |||||||||
| NPI: | 1578578993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORKOS | ||||||||
| FirstName: | FATEN | ||||||||
| MiddleName: | FARID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 319 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | NUTLEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071101935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736615170 | ||||||||
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| Practice Location | |||||||||
| Address1: | 741 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071044309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734831300 | ||||||||
| FaxNumber: | 9734833787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 06/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA08120700 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0108863 | 05 | NJ | MEDICAID | 19727784113 | 01 | NJ | 1150 SPRINGFIELD AVENUE | OTHER | 1235300799 | 01 | NJ | 37 N DAY | OTHER | 1932370483 | 01 | NJ | 101 LUDLOW | OTHER | 1194996645 | 01 | NJ | 444 WILLIAM STREET | OTHER | 1740345693 | 01 | NJ | 741 BROADWAY | OTHER |