Healthcare Provider Details

I. General information

NPI: 1013997980
Provider Name (Legal Business Name): TAL DAGAN MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MADISON AVE SUITE 503
NEW YORK NY
10017-1107
US

IV. Provider business mailing address

420 MADISON AVE SUITE 503
NEW YORK NY
10017-1107
US

V. Phone/Fax

Practice location:
  • Phone: 212-585-3242
  • Fax: 866-401-0389
Mailing address:
  • Phone: 212-585-3242
  • Fax: 866-401-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number236976
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number236976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: