Provider Demographics
NPI:1487649059
Name:TABARI, ISAAC (DPM)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
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 1:1665 E 7TH ST
Mailing Address - Street 2:APT. 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7068
Mailing Address - Country:US
Mailing Address - Phone:212-288-3137
Mailing Address - Fax:718-233-2630
Practice Address - Street 1:136 E 57TH ST
Practice Address - Street 2:SUITE 801
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2707
Practice Address - Country:US
Practice Address - Phone:212-288-3137
Practice Address - Fax:718-233-2630
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005693213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01811930Medicaid
NY01811930Medicaid
U87052Medicare UPIN