Provider Demographics
NPI:1316110133
Name:JOHN A TALLIA
Entity type:Organization
Organization Name:JOHN A TALLIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-513-5333
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1818
Mailing Address - Country:US
Mailing Address - Phone:845-786-3804
Mailing Address - Fax:845-786-3804
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1818
Practice Address - Country:US
Practice Address - Phone:845-786-3804
Practice Address - Fax:845-786-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-13
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY003835-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5506210001Medicare NSC