Provider Demographics
NPI:1023023462
Name:TALANGBAYAN, LEIZLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIZLE
Middle Name:
Last Name:TALANGBAYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 2ND AVE
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6303
Mailing Address - Country:US
Mailing Address - Phone:732-923-6806
Mailing Address - Fax:732-923-6006
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6806
Practice Address - Fax:732-923-6006
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA080729002085R0202X
NY2399642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0141488Medicaid
I60559Medicare UPIN
NJ114848VA1Medicare PIN