Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 342571 | NY |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 342571 | NY |
NPI | 1932691532 |
---|---|
Provider Name | Mrs. Tala Fanek |
First Address | Yonkers, NY 10710-1004 |
Second Address | New York, NY 10032-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 31/05/2018 |