Basic Information
| Provider Information | |||||||||
| NPI: | 1942466974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARHEEN | ||||||||
| FirstName: | AMTUL | ||||||||
| MiddleName: | SAKINA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180182256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845265210 | ||||||||
| FaxNumber: | 4845265237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180182256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845265210 | ||||||||
| FaxNumber: | 4845265237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 12/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD442069 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1027604930001 | 05 | PA | MEDICAID |