Healthcare Provider Details

I. General information

NPI: 1770043093
Provider Name (Legal Business Name): NAYIBETH TALLAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 CRESTON AVE
BRONX NY
10468-1806
US

IV. Provider business mailing address

25 CLARKSON CT
PARAMUS NJ
07652-5505
US

V. Phone/Fax

Practice location:
  • Phone: 718-367-0211
  • Fax: 646-337-2890
Mailing address:
  • Phone: 347-638-7007
  • Fax: 646-337-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31855901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: