Healthcare Provider Details

I. General information

NPI: 1932691532
Provider Name (Legal Business Name): TALA AWAD FANEK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TALA AWAD NP

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

IV. Provider business mailing address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4600
  • Fax: 212-305-7439
Mailing address:
  • Phone: 212-305-4600
  • Fax: 212-305-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: