Healthcare Provider Details

I. General information

NPI: 1205150570
Provider Name (Legal Business Name): TAL DAGAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MADISON AVE SUITE 503 AND SUITE 505
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 Code207Y00000X
TaxonomyOtolaryngology Physician
License Number236976
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number236976
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number236976
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number236976
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number236976
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number236976
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number236976
License Number StateNY

VIII. Authorized Official

Name: DR. TAL DAGAN
Title or Position: PRESIDENT
Credential: MD
Phone: 212-585-3242