Individual provider Active NPI

Linda Regis Tallaksen, PA

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1780832485
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001641-1 Issued in NY
Practice address
195 Montague St
Brooklyn, NY 11201-3628
Phone
(718) 422-8000
Fax
(718) 422-8265
NPI assigned
Sep 5, 2008
Last updated
Sep 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001641-1 NY Primary

Addresses

Primary practice location

195 Montague St
Brooklyn, NY 11201-3628

Mailing address

55 Water St FL 2
New York, NY 10041-0010
Phone (646) 680-2888

Other practice location 1

4771 Hylan Blvd
Staten Island, NY 10312-6315
Phone (718) 948-8200

Other practice location 2

1000 Church Ave
Brooklyn, NY 11218-2710
Phone (718) 826-4000

Other practice location 3

1050 Clove Road
Staten Island, NY 10301-3627
Phone (718) 816-6440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140129000071 NY Practitioner - Physician Assistant 6002045796 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001641-1NYMDMental Health Counselor
001641NYMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Brooklyn Medical Group PC Past Accepting new patients

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: ltallaksen12049@direct.acpny.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758844800000",
    "number": "1780832485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER ST FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410010",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 MONTAGUE ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112013628",
            "telephone_number": "718-422-8000",
            "fax_number": "718-422-8265"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4771 Hylan Blvd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103126315",
            "country_code": "US",
            "telephone_number": "718-948-8200",
            "fax_number": "718-317-4111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Church Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112182710",
            "country_code": "US",
            "telephone_number": "718-826-4000",
            "fax_number": "718-826-4075",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Clove Road",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103013627",
            "country_code": "US",
            "telephone_number": "718-816-6440",
            "fax_number": "718-420-2718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TALLAKSEN",
        "first_name": "LINDA",
        "middle_name": "REGIS",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-05",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "001641-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.