Healthcare Provider Details

I. General information

NPI: 1053596239
Provider Name (Legal Business Name): DR. IRA TARTACK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 OCEAN PKWY #LA
BROOKLYN NY
11235-7749
US

IV. Provider business mailing address

2650 OCEAN PKWY #LA
BROOKLYN NY
11235-7749
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-7800
  • Fax: 718-934-5478
Mailing address:
  • Phone: 718-769-7800
  • Fax: 718-934-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN002391
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberN002391
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberN002391
License Number StateNY

VIII. Authorized Official

Name: DR. IRA MELVIN TARTACK
Title or Position: DOCTOR/OWNER
Credential: D.P.M.
Phone: 718-769-7800