Provider Demographics
NPI:1497814933
Name:SENIORSTAT PSYCHIATRIC PC
Entity Type:Organization
Organization Name:SENIORSTAT PSYCHIATRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-604-5037
Mailing Address - Street 1:40 SUNSET RD S
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1149
Mailing Address - Country:US
Mailing Address - Phone:718-604-5037
Mailing Address - Fax:718-363-6630
Practice Address - Street 1:891 NORTHERN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5305
Practice Address - Country:US
Practice Address - Phone:516-829-5483
Practice Address - Fax:516-829-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02105604Medicaid
NY92N191Medicare PIN
NY08131Medicare PIN
NY08131IMedicare PIN
NYA400000570Medicare PIN
08131GMedicare PIN
NY02105604Medicaid
NYS89924Medicare UPIN