Healthcare Provider Details

I. General information

NPI: 1245603604
Provider Name (Legal Business Name): KALI ZIBA TANGUAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALI ZIBA-TANGUAY PH.D.

II. Dates (important events)

Enumeration Date: 11/07/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 W 131ST ST APT 2C
NEW YORK NY
10037-3505
US

IV. Provider business mailing address

26 W 131ST ST APT 2C
NEW YORK NY
10037-3505
US

V. Phone/Fax

Practice location:
  • Phone: 917-975-3130
  • Fax:
Mailing address:
  • Phone: 917-975-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number021357-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021357-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number021357-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: