Provider Demographics
NPI:1306167721
Name:FARAG, MARIANNE (DO)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:FARAG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:FARAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:268 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2011
Mailing Address - Country:US
Mailing Address - Phone:973-877-5688
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:DEPT OF PSYCHIATRY-BEHAVIORAL HEALTH CENTER RM N326
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-1939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB088608002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program