Provider Demographics
NPI:1932691532
Name:FANEK, TALA AWAD (NP)
Entity Type:Individual
Prefix:MRS
First Name:TALA
Middle Name:AWAD
Last Name:FANEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TALA
Other - Middle Name:
Other - Last Name:AWAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:173 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3739
Mailing Address - Country:US
Mailing Address - Phone:212-305-4600
Mailing Address - Fax:212-305-7439
Practice Address - Street 1:173 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3739
Practice Address - Country:US
Practice Address - Phone:212-305-4600
Practice Address - Fax:212-305-7439
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342571363LF0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily