MEDICARE: ARBEN TABAKU RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	624765	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	624765	OTHER	NY	REGISTER PROFESSIONAL NURSE

General Provider Information

NPI Number	:	1598282204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARBEN TABAKU RN

Provider Business Mailing Address
First Line	:	12211 82ND RD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1432
Country	:	US
Telephone Number	:	917-670-6107
Fax Number	:	718-459-3637

Provider Business Practice Location Address
First Line	:	6817 AUSTIN ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4237
Country	:	US
Telephone Number	:	718-830-4970
Fax Number	:	718-459-3637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	06/16/2018

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