Healthcare Provider Details

I. General information

NPI: 1912838533
Provider Name (Legal Business Name): TALITHA A BLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SARATOGA AVE APT 314
BROOKLYN NY
11233-5376
US

IV. Provider business mailing address

430 SARATOGA AVE APT 314
BROOKLYN NY
11233-5376
US

V. Phone/Fax

Practice location:
  • Phone: 718-781-9490
  • Fax:
Mailing address:
  • Phone: 718-781-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: