Provider Demographics
NPI:1780832485
Name:TALLAKSEN, LINDA REGIS (PA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:REGIS
Last Name:TALLAKSEN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:195 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3628
Practice Address - Country:US
Practice Address - Phone:718-422-8000
Practice Address - Fax:718-422-8265
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2019-09-30
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Provider Licenses
StateLicense IDTaxonomies
NY001641-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant