Provider Demographics
NPI:1598095267
Name:KORBAN, TAREK (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:KORBAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3608
Mailing Address - Country:US
Mailing Address - Phone:914-500-8985
Mailing Address - Fax:914-500-8986
Practice Address - Street 1:55 W RED OAK LN
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10604-3608
Practice Address - Country:US
Practice Address - Phone:914-500-8985
Practice Address - Fax:914-500-8986
Is Sole Proprietor?:No
Enumeration Date:2010-01-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271535204E00000X, 208600000X
NY0566481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery