Provider Demographics
NPI:1306571740
Name:TAL MEDNICK MD PC
Entity type:Organization
Organization Name:TAL MEDNICK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-309-5222
Mailing Address - Street 1:350 VETERANS MEMORIAL HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4316
Mailing Address - Country:US
Mailing Address - Phone:631-309-5222
Mailing Address - Fax:631-303-3380
Practice Address - Street 1:350 VETERANS MEMORIAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4316
Practice Address - Country:US
Practice Address - Phone:631-309-5222
Practice Address - Fax:631-303-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY270642OtherLICENSE