Healthcare Provider Details

I. General information

NPI: 1174576250
Provider Name (Legal Business Name): JEFFREY LEON TARLOW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

15 PLYMOUTH RD
WESTFIELD NJ
07090-3434
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax: 212-951-3378
Mailing address:
  • Phone: 908-232-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number32277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: