Provider Demographics
NPI:1336240886
Name:TARDI, JAMES PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:TARDI
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 1:295 WOODHOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0719
Mailing Address - Country:US
Mailing Address - Phone:516-729-3653
Mailing Address - Fax:631-446-4122
Practice Address - Street 1:1249 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4916
Practice Address - Country:US
Practice Address - Phone:516-729-3653
Practice Address - Fax:631-446-4122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPL8481OtherBLUE CROSS BLUE SHIELD
NYPJ563ZZRQ1Medicare PIN
NYPL8481OtherBLUE CROSS BLUE SHIELD
NY5710600001Medicare NSC
NYRB2465Medicare PIN
NYPJ5631Medicare ID - Type Unspecified