Healthcare Provider Details

I. General information

NPI: 1225078553
Provider Name (Legal Business Name): RAFAEL TABARI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 E TREMONT AVE
BRONX NY
10460-4363
US

IV. Provider business mailing address

930 E TREMONT AVE
BRONX NY
10460-4363
US

V. Phone/Fax

Practice location:
  • Phone: 718-764-1633
  • Fax: 646-224-1320
Mailing address:
  • Phone: 718-764-1633
  • Fax: 646-224-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: