Individual
TAREQ COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4422 3RD AVE, BRONX, NY 10457-2594
(718) 960-9000
Mailing address
4422 3RD AVE, BRONX, NY 10457-2594
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
032526
NY
363AS0400X
Surgical Physician Assistant
032526
NY
363AS0400X
Surgical Physician Assistant
Primary
—
NY
Other
Enumeration date
08/09/2024
Last updated
02/27/2026
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