Provider Demographics
NPI:1871981761
Name:TABATABAI, FARINAZ (CRNP)
Entity type:Individual
Prefix:
First Name:FARINAZ
Middle Name:
Last Name:TABATABAI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 CLINTON AVE
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1412
Mailing Address - Country:US
Mailing Address - Phone:973-399-1002
Mailing Address - Fax:
Practice Address - Street 1:900 PLAZA DR
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2448
Practice Address - Country:US
Practice Address - Phone:570-368-3321
Practice Address - Fax:570-601-8542
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner