Provider Demographics
NPI:1447517511
Name:FALKOWITZ, DARIA MARIE (DO)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:MARIE
Last Name:FALKOWITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:551-996-3192
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:551-996-3192
Practice Address - Fax:551-996-4239
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10780800207PT0002X, 207P00000X
NY272594207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB10780800OtherNJ STATE LICENSE