Provider Demographics
NPI:1821120767
Name:TAGLIALATELA, ALLAN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JOHN
Last Name:TAGLIALATELA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 COATES AVE N
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1210
Mailing Address - Country:US
Mailing Address - Phone:631-588-0420
Mailing Address - Fax:
Practice Address - Street 1:70 COATES AVE N
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1210
Practice Address - Country:US
Practice Address - Phone:631-588-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006441-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor