Provider Demographics
NPI:1225078553
Name:TABARI, RAFAEL (DPM)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:TABARI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4363
Mailing Address - Country:US
Mailing Address - Phone:718-764-1633
Mailing Address - Fax:646-224-1320
Practice Address - Street 1:930 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4363
Practice Address - Country:US
Practice Address - Phone:718-764-1633
Practice Address - Fax:646-224-1320
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005686213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN005686OtherSTATE LICENSE NUMBER
NY02534123Medicaid
NY02534123Medicaid
NY02534123Medicaid
NYPJ1591Medicare PIN