Healthcare Provider Details

I. General information

NPI: 1821559121
Provider Name (Legal Business Name): PEREL ETHEL BURSKY-TAMMAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 BEACH 20TH ST
FAR ROCKAWAY NY
11691-3621
US

IV. Provider business mailing address

377 ELM ST
WEST HEMPSTEAD NY
11552-3224
US

V. Phone/Fax

Practice location:
  • Phone: 347-619-5950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31882601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: