Basic Information
Provider Information
NPI: 1033571849
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAL
FirstName: ODED
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5024
Address2:  
City: NEW YORK
State: NY
PostalCode: 100875024
CountryCode: US
TelephoneNumber: 8006274470
FaxNumber: 4129375710
Practice Location
Address1: 1 GUSTAVE L LEVY PL
Address2:  
City: NEW YORK
State: NY
PostalCode: 100296504
CountryCode: US
TelephoneNumber: 8006274470
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/22/2016
LastUpdateDate: 07/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XME145089FLN Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X310190NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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