Provider Demographics
NPI:1558941260
Name:ALSHAMMARY, FARAH (DO)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:ALSHAMMARY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 UNION BLVD STE 16
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2422
Mailing Address - Country:US
Mailing Address - Phone:973-938-5200
Mailing Address - Fax:973-938-5191
Practice Address - Street 1:650 UNION BLVD STE 16
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2422
Practice Address - Country:US
Practice Address - Phone:973-938-5200
Practice Address - Fax:973-938-5191
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB12415200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine