Provider Demographics
NPI:1164571485
Name:TAREK MARDAM BEY MD PC
Entity Type:Organization
Organization Name:TAREK MARDAM BEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARDAM BEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-663-8600
Mailing Address - Street 1:1090 AMSTERDAM AVENUE
Mailing Address - Street 2:SUITE 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-663-8600
Mailing Address - Fax:212-663-8602
Practice Address - Street 1:1090 AMSTERDAM AVENUE
Practice Address - Street 2:SUITE 6E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-663-8600
Practice Address - Fax:212-663-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1265861207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00306189Medicaid
NY33879OtherEMPIRE BCBS NEW YORK
NY338791Medicare PIN
NY33879OtherEMPIRE BCBS NEW YORK