Healthcare Provider Details

I. General information

NPI: 1164118410
Provider Name (Legal Business Name): AANCHAL TYAGI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BROADWAY FL 1
NEW YORK NY
10012-2614
US

IV. Provider business mailing address

632 BROADWAY FL 1
NEW YORK NY
10012-2614
US

V. Phone/Fax

Practice location:
  • Phone: 212-432-5847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number346434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: