Provider Demographics
NPI:1174711188
Name:JOHN FARENS MD PC
Entity type:Organization
Organization Name:JOHN FARENS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:FARENS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:203-926-1206
Mailing Address - Street 1:224 LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1809
Mailing Address - Country:US
Mailing Address - Phone:203-926-1206
Mailing Address - Fax:203-926-0413
Practice Address - Street 1:224 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1809
Practice Address - Country:US
Practice Address - Phone:203-926-1206
Practice Address - Fax:203-926-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028528207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1285289Medicaid
CT1285289Medicaid
CTE45107Medicare UPIN