Provider Demographics
NPI:1962573923
Name:ALFARO, ABRAHAM (DO, PHD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:ALFARO
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 ROUTE 66
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-807-0880
Mailing Address - Fax:732-791-9577
Practice Address - Street 1:61 W. JIMMIE LEEDS ROAD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-0723
Practice Address - Country:US
Practice Address - Phone:609-748-5380
Practice Address - Fax:609-652-8749
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB064099208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7049609Medicaid
NJ7049609Medicaid
NJ529534Medicare PIN