Healthcare Provider Details

I. General information

NPI: 1972133056
Provider Name (Legal Business Name): TAYLOR TALASKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CENTER ST APT 2
LOCK HAVEN PA
17745-2710
US

IV. Provider business mailing address

311 CENTER ST APT 2
LOCK HAVEN PA
17745-2710
US

V. Phone/Fax

Practice location:
  • Phone: 716-499-9517
  • Fax:
Mailing address:
  • Phone: 716-499-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMA061361
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMA061361
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPENNSYLVANIA STATE BOARD OF MEDICINE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: