Healthcare Provider Details

I. General information

NPI: 1922494160
Provider Name (Legal Business Name): TALINA KUZNETSOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FRANKLIN AVE
VALLEY STREAM NY
11580-2145
US

IV. Provider business mailing address

234 E 149TH ST
BRONX NY
10451-5504
US

V. Phone/Fax

Practice location:
  • Phone: 516-256-6000
  • Fax: 516-256-6675
Mailing address:
  • Phone: 718-579-5874
  • Fax: 718-579-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number295475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: