Individual provider Active NPI

Alan R Tajerstein, DPM

  • Podiatrist
  • Brooklyn, NY
National Provider Identifier
1891782587
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
N004639 Issued in NY
Practice address
1468 E 10TH St
Brooklyn, NY 11230-6504
Phone
(718) 972-5000
Fax
(718) 972-3774
NPI assigned
Sep 29, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X N004639 NY Primary
Podiatrist 213E00000X 25MD00244000 NJ
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1468 E 10TH St
Brooklyn, NY 11230-6504

Mailing address

2802 Avenue P
Brooklyn, NY 11229-1810
Phone (718) 972-5000

Other identifiers 1

IdentifierTypeStateIssuer
01151000MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080401000390 NY Practitioner - Podiatry 8921010547 Reassigns benefits to 1 organization
Practice locations: Hempstead, NY; Flushing, NY; Brooklyn, NY
I20101122000668 NJ Practitioner - Podiatry 8921010547 Reassigns benefits to 1 organization
Practice locations: Englishtown, NJ; Long Branch, NJ; Somerset, NJ; Wayne, NJ

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25MD00244000NJMDPodiatrist
N004639NYMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
East Coast Podiatric Medicine and Surgery LLC CurrentSince Mar 2, 2006 Accepting new patients
Eastern Podiatry PLLC Podiatrist CurrentSince Jan 5, 2011 Accepting new patients
Back Office Management Services LLC Podiatrist Past Accepting new patients
Back Office Management Services LLC Podiatrist PastSince Oct 16, 2009 Accepting new patients
Back Office Management Services LLC Past Accepting new patients
Eastern Podiatry PLLC Past Accepting new patients
Eastern Podiatry PLLC Podiatrist Past Accepting new patients
Back Office Management Services LLC Podiatrist Past Accepting new patients

Locations

620 Montgomery St
Jersey City, NJ 07302
Phone (201) 435-0033

380 Demott Ln
Somerset, NJ 08873
Phone (732) 873-2000

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480464000000",
    "number": "1891782587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2802 AVENUE P",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291810",
            "telephone_number": "718-972-5000",
            "fax_number": "718-972-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 E 10TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112306504",
            "telephone_number": "718-972-5000",
            "fax_number": "718-972-3774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAJERSTEIN",
        "first_name": "ALAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2016-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N004639",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00244000",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01151000",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.