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General NPI Number Information
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NPI Number | 1790251544
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Entity Type | Individual
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Provider Name | TRYSTAN GANGI
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Gender | Male
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 119 TOMPKINS AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2601
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Country | US
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Telephone | 347-749-7669
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Fax |
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Provider Business Mailing Address
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Address Line | 97 RICHARD LN
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1621
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Country | US
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Telephone | 718-887-4057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NY
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