Provider Information for 1568730794
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MARY FARAG
Sex: Female
NPI: 1568730794
Last Updated: 2016-09-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1568730794 | ||||||||
| Enumeration Date | 2011-12-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1315 WALNUT ST STE 320 PHILADELPHIA, PA 19107-4701 United States Phone: 856-203-7295 | Fax: | ||||||||
| Primary Practice Address | 1 MARKET ST APT.636 CAMDEN, NJ 08102-2308 United States Phone: 856-203-7295 | Fax: | ||||||||
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