Provider Demographics
NPI:1881811925
Name:TALLINI, GARY LAWRENCE (FNP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LAWRENCE
Last Name:TALLINI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BRADHURST AVE
Mailing Address - Street 2:PEDIATRIC DEPARTMENT
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1637
Mailing Address - Country:US
Mailing Address - Phone:914-592-7555
Mailing Address - Fax:914-831-1291
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1637
Practice Address - Country:US
Practice Address - Phone:914-592-7555
Practice Address - Fax:914-831-1291
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily