Basic Information
| Provider Information | |||||||||
| NPI: | 1174517635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | PRACTICE ASSOCIATES MEDICAL GROUP | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736566280 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 571 CENTRAL AVE STE 115 | ||||||||
| Address2: | ASSOCIATES IN CARDIOVASCULAR DISEASE LLC | ||||||||
| City: | NEW PROVIDENCE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079741547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084644200 | ||||||||
| FaxNumber: | 9084641332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA03168600 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1815903 | 05 | NJ | MEDICAID |