Basic Information
| Provider Information | |||||||||
| NPI: | 1992110621 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN A FARENS M.D. PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 LEAVENWORTH RD | ||||||||
| Address2: | |||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064841881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039261206 | ||||||||
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| Practice Location | |||||||||
| Address1: | 224 LEAVENWORTH RD | ||||||||
| Address2: | |||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064841881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039261206 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | FARENS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | AUGUSTINE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2039261206 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., F.A.C.P | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 053173 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.