Provider Demographics
NPI:1780601674
Name:TALMOR, MIA (MD)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:TALMOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 LAUREL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-9635
Mailing Address - Country:US
Mailing Address - Phone:516-659-4307
Mailing Address - Fax:
Practice Address - Street 1:742 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4251
Practice Address - Country:US
Practice Address - Phone:212-740-2100
Practice Address - Fax:646-396-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199082208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH40136Medicare UPIN