Provider Demographics
NPI:1528307535
Name:TAL, SARA (PA)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:
Last Name:TAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6485 WETHEROLE ST APT 6B
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4047
Mailing Address - Country:US
Mailing Address - Phone:212-987-1000
Mailing Address - Fax:212-987-1754
Practice Address - Street 1:1035 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0912
Practice Address - Country:US
Practice Address - Phone:212-987-1000
Practice Address - Fax:212-987-1754
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012574363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical