Healthcare Provider Details

I. General information

NPI: 1639356579
Provider Name (Legal Business Name): DANIEL TAGLIAVIA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 BURNSIDE AVE
INWOOD NY
11096-1300
US

IV. Provider business mailing address

591 BURNSIDE AVE
INWOOD NY
11096-1300
US

V. Phone/Fax

Practice location:
  • Phone: 516-371-2828
  • Fax: 516-371-7814
Mailing address:
  • Phone: 516-371-2828
  • Fax: 516-371-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: