Provider Demographics
NPI:1710951355
Name:TAL, MOTY NACHUM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOTY
Middle Name:NACHUM
Last Name:TAL
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 1:1300 HIGHWAY 35
Mailing Address - Street 2:PLAZA 2 SUITE 202
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3537
Mailing Address - Country:US
Mailing Address - Phone:732-517-0555
Mailing Address - Fax:732-517-1359
Practice Address - Street 1:1300 HIGHWAY 35
Practice Address - Street 2:PLAZA 2 SUITE 202
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3537
Practice Address - Country:US
Practice Address - Phone:732-517-0555
Practice Address - Fax:732-517-1359
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03717300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ441739Medicare ID - Type Unspecified
NJC54552Medicare UPIN