Provider Demographics
NPI:1831327337
Name:FARAJALLAH, AWNY (MD)
Entity type:Individual
Prefix:DR
First Name:AWNY
Middle Name:
Last Name:FARAJALLAH
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 1:777 SCUDDERS MILL RD
Mailing Address - Street 2:MS P11-26
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1615
Mailing Address - Country:US
Mailing Address - Phone:609-897-3124
Mailing Address - Fax:609-897-6068
Practice Address - Street 1:777 SCUDDERS MILL RD
Practice Address - Street 2:MS P11-26
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1615
Practice Address - Country:US
Practice Address - Phone:609-897-3124
Practice Address - Fax:609-897-6068
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1388207RI0200X
NJ25MA07408000207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140551001Medicaid
AR140551001Medicaid