Provider Demographics
NPI:1760689475
Name:TARANOW, DOUGLAS ADAM (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ADAM
Last Name:TARANOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5163
Mailing Address - Country:US
Mailing Address - Phone:212-772-2100
Mailing Address - Fax:
Practice Address - Street 1:169 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5163
Practice Address - Country:US
Practice Address - Phone:212-772-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179970208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGO2823Medicare UPIN