Provider Demographics
NPI:1902863863
Name:TALLO, LOUIS J (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:TALLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 S CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2623
Mailing Address - Country:US
Mailing Address - Phone:585-473-5051
Mailing Address - Fax:
Practice Address - Street 1:2225 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2623
Practice Address - Country:US
Practice Address - Phone:585-473-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003613-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12189CMedicare ID - Type Unspecified
NYT26186Medicare UPIN