Provider Demographics
NPI:1497804728
Name:TAREK MARDAM BEY MD LLC
Entity Type:Organization
Organization Name:TAREK MARDAM BEY MD LLC
Other - Org Name:TAREK MARDAM BEY MD
Other - Org Type:Former Legal Business Name
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:MF
Authorized Official - Phone:201-569-0061
Mailing Address - Street 1:2 DEAN DRIVE
Mailing Address - Street 2:1ST FLOOR
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59666207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD063061OtherCDS
NJ6309305Medicaid
NJD063061OtherCDS
C08725Medicare UPIN