Provider Demographics
NPI:1962040642
Name:TABAK, MIRIAM (MS)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:TABAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 46TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2163
Mailing Address - Country:US
Mailing Address - Phone:917-586-5999
Mailing Address - Fax:
Practice Address - Street 1:1327 46TH ST APT 3D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2163
Practice Address - Country:US
Practice Address - Phone:917-586-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171092207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics