Healthcare Provider Details

I. General information

NPI: 1700440187
Provider Name (Legal Business Name): TALEEN MUIN KAKISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 LAKEVIEW AVE
CLIFTON NJ
07011-4016
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-3088
  • Fax: 888-927-0479
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA1151390
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: