Provider Demographics
NPI:1548516800
Name:TALLEUR, DIANE L
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:L
Last Name:TALLEUR
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 1:22 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7421
Mailing Address - Country:US
Mailing Address - Phone:631-683-4669
Mailing Address - Fax:631-549-1005
Practice Address - Street 1:709 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6336
Practice Address - Country:US
Practice Address - Phone:631-549-1280
Practice Address - Fax:631-549-1005
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator