Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 333859 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 333859 | NY |
N | 363LW0102X | Nurse Practitioner - Women's Health | 333859 | NY |
NPI | 1043217300 |
---|---|
Provider Name | Dr. Phyllis A Tarallo |
First Address | New York, NY 10087-7036 |
Second Address | Teaneck, NJ 07666-4245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0269026 | (05) | NY |