Healthcare Provider Details

I. General information

NPI: 1629470505
Provider Name (Legal Business Name): MARIELLA LISET TALIBONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAKE ST
HILLBURN NY
10931-2001
US

IV. Provider business mailing address

15 CENTER ST
RAMSEY NJ
07446-2325
US

V. Phone/Fax

Practice location:
  • Phone: 845-641-2717
  • Fax:
Mailing address:
  • Phone: 201-887-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number860129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: