MEDICARE: MIA TALMOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	199082	NY

General Provider Information

NPI Number	:	1780601674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA TALMOR M.D.

Provider Business Mailing Address
First Line	:	1542 LAUREL HOLLOW RD
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-9635
Country	:	US
Telephone Number	:	516-659-4307
Fax Number	:

Provider Business Practice Location Address
First Line	:	742 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4251
Country	:	US
Telephone Number	:	212-740-2100
Fax Number	:	646-396-5644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/07/2022

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