Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 1265861 | NY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 1265861 | NY |
NPI | 1114076437 |
---|---|
Provider Name | Tarek H Mardam-Bey |
First Address | Tenafly, NJ 07670 |
Second Address | Tenafly, NJ 07670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 17/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00306189 | (05) | NY |
6309305 | (05) | NJ |
C08725 | (02) |