Healthcare Provider Details

I. General information

NPI: 1457761470
Provider Name (Legal Business Name): CHEIKH TALAL EL IMAD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date: 12/01/2014
Reactivation Date: 01/26/2015

III. Provider practice location address

1055 STEWART AVENUE
BETHPAGE NY
11714-3596
US

IV. Provider business mailing address

55 WATER ST FL 2
NEW YORK NY
10041-0010
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-0100
  • Fax: 516-938-0120
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number294895
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: