Provider Demographics
NPI:1063054930
Name:ABBAS, FARHAT
Entity type:Individual
Prefix:
First Name:FARHAT
Middle Name:
Last Name:ABBAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SALEM WALK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7133
Mailing Address - Country:US
Mailing Address - Phone:203-435-6989
Mailing Address - Fax:
Practice Address - Street 1:7 LOLLER RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-4315
Practice Address - Country:US
Practice Address - Phone:203-435-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3580172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver