Provider Demographics
NPI:1912953175
Name:GANGI, ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GANGI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PARK AVE S
Mailing Address - Street 2:APT 12H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6130
Mailing Address - Country:US
Mailing Address - Phone:212-380-8059
Mailing Address - Fax:212-212-3880
Practice Address - Street 1:280 PARK AVE S
Practice Address - Street 2:SUITE 12H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6121
Practice Address - Country:US
Practice Address - Phone:212-380-8059
Practice Address - Fax:718-238-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016221-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical