Healthcare Provider Details

I. General information

NPI: 1235292830
Provider Name (Legal Business Name): NICOLE BARBARA TALAY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 LAKE AVE STE 101
SAINT JAMES NY
11780-2933
US

IV. Provider business mailing address

22 LEARY LN
NESCONSET NY
11767-1810
US

V. Phone/Fax

Practice location:
  • Phone: 631-335-1569
  • Fax:
Mailing address:
  • Phone: 631-584-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberX0091491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: