MEDICARE: DR. ADIT LIOR TAL M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922445972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADIT LIOR TAL M.D.

Provider Business Mailing Address
First Line	:	21870 HARTLAND AVE
Second Line	:
City	:	HOLLIS HILLS
State	:	NY
Zip	:	11364-3533
Country	:	US
Telephone Number	:	917-957-5478
Fax Number	:

Provider Business Practice Location Address
First Line	:	21870 HARTLAND AVE
Second Line	:
City	:	HOLLIS HILLS
State	:	NY
Zip	:	11364-3533
Country	:	US
Telephone Number	:	917-957-5478
Fax Number	:

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

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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