| Doctor Name: | DR. MANUEL TALAVERA |
| NPI Number: | 1801811633 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 099616 |
| Business Practice Address: | 1575 Hillside Ave Suite Ll1 New Hyde Park, NY - 110402501 |
| Business Phone Number: | 5166167600 |
| Business Fax Number: | 5166164821 |
| Mailing Address: | 3441 85th St, Apt 2b JACKSON HEIGHTS |
| State: | NY |
| Postal Code: | 113723246 |
| Phone Number: | 7186726580 |
| Fax Number: | |
| NPI Enumeration Date: | 07/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 099616 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |