Provider Demographics
NPI:1316698145
Name:BEN MAZIA HATUEL, TALIA
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:BEN MAZIA HATUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 W 87TH ST # 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2847
Mailing Address - Country:US
Mailing Address - Phone:917-420-2310
Mailing Address - Fax:
Practice Address - Street 1:247 W 87TH ST # 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2847
Practice Address - Country:US
Practice Address - Phone:917-420-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN