Provider Demographics
NPI:1649270646
Name:TALLIA, JOHN ALFRED (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALFRED
Last Name:TALLIA
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 1:109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1818
Mailing Address - Country:US
Mailing Address - Phone:845-513-5333
Mailing Address - Fax:845-513-5333
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1818
Practice Address - Country:US
Practice Address - Phone:845-513-5333
Practice Address - Fax:845-513-5333
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2024-08-16
Deactivation Date:2024-08-02
Deactivation Code:
Reactivation Date:2024-08-16
Provider Licenses
StateLicense IDTaxonomies
NYN4 3835-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T51207Medicare UPIN
NYP39422Medicare ID - Type Unspecified