Provider Demographics
NPI:1932262441
Name:TALAY FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:TALAY FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TALAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-335-1569
Mailing Address - Street 1:187 LAKE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2933
Mailing Address - Country:US
Mailing Address - Phone:631-335-1569
Mailing Address - Fax:
Practice Address - Street 1:187 LAKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2933
Practice Address - Country:US
Practice Address - Phone:631-335-1569
Practice Address - Fax:631-584-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0091491111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXQW301Medicare ID - Type Unspecified