Healthcare Provider Details

I. General information

NPI: 1134189897
Provider Name (Legal Business Name): TALAAT ABDELMONEIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 12/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BURNHAM LN
DIX HILLS NY
11746-5402
US

IV. Provider business mailing address

PO BOX 31694
HARTFORD CT
06150
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-1123
  • Fax:
Mailing address:
  • Phone: 212-256-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number185933
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number185933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: