Healthcare Provider Details

I. General information

NPI: 1164571485
Provider Name (Legal Business Name): TAREK MARDAM BEY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 AMSTERDAM AVENUE SUITE 6E
NEW YORK NY
10025
US

IV. Provider business mailing address

1090 AMSTERDAM AVENUE SUITE 6E
NEW YORK NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-8600
  • Fax: 212-663-8602
Mailing address:
  • Phone: 212-663-8600
  • Fax: 212-663-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1265861
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number1265861
License Number StateNY

VIII. Authorized Official

Name: TAREK H MARDAM BEY
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 212-663-8600