Provider Demographics
NPI:1013997980
Name:DAGAN, TAL (MD FACS)
Entity Type:Individual
Prefix:
First Name:TAL
Middle Name:
Last Name:DAGAN
Suffix:
Gender:M
Credentials:MD FACS
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Mailing Address - Street 1:420 MADISON AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1107
Mailing Address - Country:US
Mailing Address - Phone:212-585-3242
Mailing Address - Fax:866-401-0389
Practice Address - Street 1:420 MADISON AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1107
Practice Address - Country:US
Practice Address - Phone:212-585-3242
Practice Address - Fax:866-401-0389
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2020-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY236976207YX0007X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02807023Medicaid
NY02807023Medicaid