MEDICARE: MASON TALLMAN

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	104100000X	Social Worker	P139957	NY

General Provider Information

NPI Number	:	1982561932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON TALLMAN

Provider Business Mailing Address
First Line	:	1170 RIVERFRONT CTR
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-4600
Country	:	US
Telephone Number	:	518-888-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 RIVERFRONT CTR
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-4600
Country	:	US
Telephone Number	:	518-888-4405
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ MASON TALLMAN ” Practice Location

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