Provider Demographics
NPI:1114076437
Name:MARDAM-BEY, TAREK H (MD)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:H
Last Name:MARDAM-BEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670
Mailing Address - Country:US
Mailing Address - Phone:201-569-0061
Mailing Address - Fax:201-569-5602
Practice Address - Street 1:2 DEAN DRIVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-569-0061
Practice Address - Fax:201-569-5602
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1265861207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6309305Medicaid
NY00306189Medicaid
NY00306189Medicaid
C08725Medicare UPIN
NJ6309305Medicaid