Healthcare Provider Details

I. General information

NPI: 1235686072
Provider Name (Legal Business Name): DAVID TZALL PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 PLAZA ST E STE 1A
BROOKLYN NY
11238-5039
US

IV. Provider business mailing address

300 8TH ST APT 2C
BROOKLYN NY
11215-7501
US

V. Phone/Fax

Practice location:
  • Phone: 202-577-3714
  • Fax:
Mailing address:
  • Phone: 202-577-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021771-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: