Provider Demographics
NPI:1326330242
Name:DUTTA, TANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:DUTTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MS
Mailing Address - Street 1:605 OLD FORGE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1026
Mailing Address - Country:US
Mailing Address - Phone:862-702-6387
Mailing Address - Fax:
Practice Address - Street 1:385 5TH AVE RM 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3340
Practice Address - Country:US
Practice Address - Phone:917-391-0076
Practice Address - Fax:913-353-3001
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3058082084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry