Individual
SHARON TAHALOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17408 JEWEL AVE, FRESH MEADOWS, NY 11365-3426
(917) 602-2396
Mailing address
17408 JEWEL AVE, FRESH MEADOWS, NY 11365-3426
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1258820
NY
Other
Enumeration date
01/27/2014
Last updated
01/27/2014
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