=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780601674
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIA TALMOR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 742 PARK AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-740-2100
-----------------------------------------------------
Fax | 646-396-5644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1542 LAUREL HOLLOW RD
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-9635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-659-4307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 199082
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------