Healthcare Provider Details

I. General information

NPI: 1124604624
Provider Name (Legal Business Name): TALIA ELIZABETH RAVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22-02 BROADWAY STE 304
FAIR LAWN NJ
07410-3016
US

IV. Provider business mailing address

506 6TH ST
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 551-246-3193
  • Fax:
Mailing address:
  • Phone: 718-780-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA13280300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: