Provider Demographics
NPI:1427133354
Name:FARENS, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FARENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1809
Mailing Address - Country:US
Mailing Address - Phone:203-926-1206
Mailing Address - Fax:203-926-0413
Practice Address - Street 1:224 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1809
Practice Address - Country:US
Practice Address - Phone:203-926-1206
Practice Address - Fax:203-926-0413
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028528207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1285289Medicaid
CT1285289Medicaid
CT110001416Medicare ID - Type Unspecified