Healthcare Provider Details

I. General information

NPI: 1497804728
Provider Name (Legal Business Name): TAREK MARDAM BEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEAN DRIVE
TENAFLY NJ
07670
US

IV. Provider business mailing address

2 DEAN DRIVE 1ST FLOOR
TENAFLY NJ
07670
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-0061
  • Fax: 201-569-5602
Mailing address:
  • Phone: 201-569-0061
  • Fax: 201-569-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMA59666
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMA59666
License Number StateNJ

VIII. Authorized Official

Name: TAREK H MARDAM BEY
Title or Position: PHYSICIAN OWNER
Credential: MF
Phone: 201-569-0061