Provider Demographics
NPI:1669477311
Name:TARTACK, IRA MELVIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:MELVIN
Last Name:TARTACK
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 1:2650 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7749
Mailing Address - Country:US
Mailing Address - Phone:718-769-7800
Mailing Address - Fax:718-934-5478
Practice Address - Street 1:2650 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7749
Practice Address - Country:US
Practice Address - Phone:718-769-7800
Practice Address - Fax:718-934-5478
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002391-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01674482Medicaid
NYT31967Medicare UPIN
NYP27201Medicare ID - Type UnspecifiedMEDICARE