Healthcare Provider Details

I. General information

NPI: 1609457407
Provider Name (Legal Business Name): DESIREE JOY ANNE M TALABONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE JOY ANNE M TIMTIMAN MD

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

1901 S VOSS RD APT 32
HOUSTON TX
77057-2600
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1000
  • Fax:
Mailing address:
  • Phone: 361-879-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number334317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: