Provider Demographics
NPI:1831373083
Name:ALTUVE, FARRAH (PA C)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:ALTUVE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 SPRUCE ST
Mailing Address - Street 2:1 CATHCART
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-2222
Mailing Address - Fax:215-829-2477
Practice Address - Street 1:85 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4561
Practice Address - Country:US
Practice Address - Phone:201-445-2830
Practice Address - Fax:215-829-2477
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2021-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00201200363AS0400X
PAMA055484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant