Provider Demographics
NPI:1861771743
Name:MASSERMAN, TAL ETHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TAL
Middle Name:ETHAN
Last Name:MASSERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E 85TH ST
Mailing Address - Street 2:APT. 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4569
Mailing Address - Country:US
Mailing Address - Phone:949-233-0387
Mailing Address - Fax:
Practice Address - Street 1:3332 ROCHAMBEAU AVE
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:949-233-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program