MEDICARE: YINABETH TALLAJ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	333094	NY

General Provider Information

NPI Number	:	1669091716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YINABETH TALLAJ

Provider Business Mailing Address
First Line	:	571 ACADEMY ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-5105
Country	:	US
Telephone Number	:	833-717-2828
Fax Number	:	347-625-6551

Provider Business Practice Location Address
First Line	:	610 ACADEMY ST STE 10A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-5058
Country	:	US
Telephone Number	:	833-717-2828
Fax Number	:	347-625-6551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	06/23/2025

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