Provider Demographics
NPI:1730371709
Name:GERASSI, TALI
Entity type:Individual
Prefix:MISS
First Name:TALI
Middle Name:
Last Name:GERASSI
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 1:85 ALHAMBRA DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5425
Mailing Address - Country:US
Mailing Address - Phone:516-428-9214
Mailing Address - Fax:
Practice Address - Street 1:85 ALHAMBRA DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5425
Practice Address - Country:US
Practice Address - Phone:516-428-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist