=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124009485
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDOCRINOLOGY,DIABETES&METABOLISM,NY,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2005
-----------------------------------------------------
Last Update Date | 05/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1097 OLD COUNTRY RD SUITE 102
-----------------------------------------------------
City | PLAINVIEW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11803-6505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-931-1007
-----------------------------------------------------
Fax | 516-931-1008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1097 OLD COUNTRY RD SUITE 102
-----------------------------------------------------
City | PLAINVIEW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11803-6505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-931-1007
-----------------------------------------------------
Fax | 516-931-1008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SONIA A TALWAR
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 516-931-1007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 208487
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------