Provider Demographics
NPI:1982611109
Name:TARKOFF, DAVID I (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:I
Last Name:TARKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516
Mailing Address - Country:US
Mailing Address - Phone:516-569-5200
Mailing Address - Fax:516-569-7403
Practice Address - Street 1:123 GROVE AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516
Practice Address - Country:US
Practice Address - Phone:516-569-5200
Practice Address - Fax:516-569-7403
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY13599207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00716433Medicaid
NY00716433Medicaid
NY78A9919221Medicare PIN
NYW19221Medicare PIN
NYCC5721Medicare PIN