Healthcare Provider Details

I. General information

NPI: 1508004375
Provider Name (Legal Business Name): RITA V TALIWAL D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2009
Last Update Date: 02/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E 50TH ST SUITE 11A
NEW YORK NY
10022-6817
US

IV. Provider business mailing address

18 E 50TH ST SUITE 11A
NEW YORK NY
10022-6817
US

V. Phone/Fax

Practice location:
  • Phone: 212-319-5777
  • Fax: 212-319-5759
Mailing address:
  • Phone: 212-319-5777
  • Fax: 212-319-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051673
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: