Provider Demographics
NPI:1790904886
Name:TALBOT, JEAN (RPAC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-7954
Mailing Address - Country:US
Mailing Address - Phone:518-283-1974
Mailing Address - Fax:518-283-2018
Practice Address - Street 1:9 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-7954
Practice Address - Country:US
Practice Address - Phone:518-283-1974
Practice Address - Fax:518-283-2018
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004891-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant