Healthcare Provider Details

I. General information

NPI: 1003860040
Provider Name (Legal Business Name): JOYCE R TALAVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 ELMER ST
WESTFIELD NJ
07090-2128
US

IV. Provider business mailing address

8 MOUNTAIN BLVD
WARREN NJ
07059-2638
US

V. Phone/Fax

Practice location:
  • Phone: 908-228-3675
  • Fax: 908-654-1053
Mailing address:
  • Phone: 908-222-0048
  • Fax: 908-222-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08692700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: