MEDICARE: DR. ROSTISLAV TABAK M.D.

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	207R00000X	Internal Medicine Physician	266289	NY

General Provider Information

NPI Number	:	1902103823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSTISLAV TABAK M.D.

Provider Business Mailing Address
First Line	:	2800 MARCUS AVE
Second Line	:	APT S27G
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1113
Country	:	US
Telephone Number	:	516-622-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E 34TH ST
Second Line	:	APT S27G
City	:	NEW YORK
State	:	NY
Zip	:	10016-4914
Country	:	US
Telephone Number	:	347-575-7180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2011
Last Update Date	:	02/14/2023

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