Provider Demographics
NPI:1265449862
Name:LYGA, MARILYN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:T
Last Name:LYGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MADISONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1665
Mailing Address - Country:US
Mailing Address - Phone:908-766-6836
Mailing Address - Fax:
Practice Address - Street 1:105 MADISONVILLE RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1665
Practice Address - Country:US
Practice Address - Phone:908-766-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060002061NJ01OtherANTHEM HEALTH PIN #
NJ4564859OtherAETNA PIN#
NJ132379000OtherMAGELLAN PROVIDER #
NJ0519219000OtherAMERIHEALTH PPO PIN #
NJLY684793Medicare ID - Type Unspecified