Provider Demographics
NPI:1245603604
Name:ZIBA TANGUAY, KALI (PHD)
Entity Type:Individual
Prefix:DR
First Name:KALI
Middle Name:
Last Name:ZIBA TANGUAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KALI
Other - Middle Name:
Other - Last Name:ZIBA-TANGUAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:26 W 131ST ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3505
Mailing Address - Country:US
Mailing Address - Phone:917-975-3130
Mailing Address - Fax:
Practice Address - Street 1:26 W 131ST ST
Practice Address - Street 2:APT 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3505
Practice Address - Country:US
Practice Address - Phone:917-975-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-07
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021357-1103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent