Provider Demographics
NPI:1528093515
Name:TARRASH, GIDEON PHILIP (DPM)
Entity type:Individual
Prefix:
First Name:GIDEON
Middle Name:PHILIP
Last Name:TARRASH
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 1:2965 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3204
Mailing Address - Country:US
Mailing Address - Phone:516-766-8500
Mailing Address - Fax:516-766-8526
Practice Address - Street 1:2965 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3204
Practice Address - Country:US
Practice Address - Phone:516-766-8500
Practice Address - Fax:516-766-8526
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004434213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01172747Medicaid
NY6310030001Medicare NSC
NYP50021Medicare PIN
NY01172747Medicaid
NY4715060001Medicare NSC
480011530Medicare PIN