Provider Demographics
NPI:1891782587
Name:TAJERSTEIN, ALAN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:TAJERSTEIN
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 1:2802 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1810
Mailing Address - Country:US
Mailing Address - Phone:718-972-5000
Mailing Address - Fax:718-972-3774
Practice Address - Street 1:1468 E 10TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6504
Practice Address - Country:US
Practice Address - Phone:718-972-5000
Practice Address - Fax:718-972-3774
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004639213E00000X
NJ25MD00244000213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01151000Medicaid
NYP50591Medicare PIN
NY02862Medicare PIN
NJ035478Medicare PIN
U17241Medicare UPIN
NY4328230001Medicare NSC