MEDICARE: BACK OFFICE MANAGEMENT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1265739973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK OFFICE MANAGEMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	2802 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1810
Country	:	US
Telephone Number	:	718-972-5000
Fax Number	:	718-972-3774

Provider Business Practice Location Address
First Line	:	4200 SHEPHERD LN
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-3423
Country	:	US
Telephone Number	:	718-972-5000
Fax Number	:	718-972-3774

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALAN TAJERSTEIN
Credential	:	D.P.M
Telephone Number	:	718-972-5000

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	03/12/2024

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