Provider Demographics
NPI:1629470505
Name:TALIBONG, MARIELLA LISET (RN)
Entity type:Individual
Prefix:
First Name:MARIELLA
Middle Name:LISET
Last Name:TALIBONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2325
Mailing Address - Country:US
Mailing Address - Phone:201-887-2541
Mailing Address - Fax:
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:
Practice Address - City:HILLBURN
Practice Address - State:NY
Practice Address - Zip Code:10931-2001
Practice Address - Country:US
Practice Address - Phone:845-641-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY860129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty