Basic Information
| Provider Information | |||||||||
| NPI: | 1942315163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARKAS | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WESTMINSTER AVE | ||||||||
| Address2: | |||||||||
| City: | BERGENFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076213913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013871957 | ||||||||
| FaxNumber: | 2013871036 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 61ST ST APT 1 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186301270 | ||||||||
| FaxNumber: | 2013510656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 25MA06920400 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 192230 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0204X | 25MA06920400 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | 192230 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02622264 | 05 | NY | MEDICAID |