Provider Demographics
NPI:1770043093
Name:TALLAJ, NAYIBETH (MD)
Entity Type:Individual
Prefix:
First Name:NAYIBETH
Middle Name:
Last Name:TALLAJ
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 1:25 CLARKSON CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5505
Mailing Address - Country:US
Mailing Address - Phone:347-638-7007
Mailing Address - Fax:
Practice Address - Street 1:2910 EXTERIOR ST FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7104
Practice Address - Country:US
Practice Address - Phone:212-740-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31855901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics