Provider Demographics
NPI:1508157116
Name:SKIBA, TOMASZ (PSYD)
Entity Type:Individual
Prefix:
First Name:TOMASZ
Middle Name:
Last Name:SKIBA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-75 48TH AVE.
Mailing Address - Street 2:APT. 212
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5502
Mailing Address - Country:US
Mailing Address - Phone:212-920-7971
Mailing Address - Fax:
Practice Address - Street 1:4-75 48TH AVE.
Practice Address - Street 2:APT. 212
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5502
Practice Address - Country:US
Practice Address - Phone:212-920-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31010OtherCLINCAL LICENSE