Provider Demographics
NPI:1053596239
Name:DR. IRA TARTACK
Entity type:Organization
Organization Name:DR. IRA TARTACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:TARTACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-769-7800
Mailing Address - Street 1:2650 OCEAN PKWY
Mailing Address - Street 2:#LA
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7749
Mailing Address - Country:US
Mailing Address - Phone:718-769-7800
Mailing Address - Fax:718-934-5478
Practice Address - Street 1:2650 OCEAN PKWY
Practice Address - Street 2:#LA
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7749
Practice Address - Country:US
Practice Address - Phone:718-769-7800
Practice Address - Fax:718-934-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002391332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0902630001Medicare NSC
NYT31967Medicare UPIN