Provider Demographics
NPI:1336189851
Name:TANGAL, HETAL
Entity Type:Individual
Prefix:DR
First Name:HETAL
Middle Name:
Last Name:TANGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 NEW LOTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-6414
Mailing Address - Country:US
Mailing Address - Phone:718-240-8950
Mailing Address - Fax:718-240-8926
Practice Address - Street 1:465 NEW LOTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6414
Practice Address - Country:US
Practice Address - Phone:718-240-8900
Practice Address - Fax:718-240-8926
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02640260Medicaid
NYI21519Medicare UPIN
NY604X91Medicare ID - Type Unspecified