Provider Demographics
NPI:1417949504
Name:TALIERCIO, FRANK C (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:C
Last Name:TALIERCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N BROADWAY
Mailing Address - Street 2:101
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2403
Mailing Address - Country:US
Mailing Address - Phone:914-949-7722
Mailing Address - Fax:914-949-1122
Practice Address - Street 1:811 N BROADWAY
Practice Address - Street 2:101
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-2403
Practice Address - Country:US
Practice Address - Phone:914-949-7722
Practice Address - Fax:914-949-1122
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-04-14
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
NY152791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY82A471Medicare ID - Type UnspecifiedPROVIDER NUMBER
NYA64402Medicare UPIN