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General NPI Number Information
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NPI Number | 1497804728
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Entity Type | Organization
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Legal Business Name | TAREK MARDAM BEY MD LLC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 2 DEAN DRIVE
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-569-0061
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Fax | 201-569-5602
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Provider Business Mailing Address
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Address Line | 2 DEAN DRIVE 1ST FLOOR
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City | TENAFLY
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State | NJ
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Zip | 07670
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Country | US
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Telephone | 201-569-0061
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Fax | 201-569-5602
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | TAREK H MARDAM BEY
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Credential | MF
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Telephone | 201-569-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | MA59666
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MA59666
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License Number State | NJ
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