Provider Demographics
NPI:1306155544
Name:TOMB, MEGHAN
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:TOMB
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 1:635 W 165TH ST FL 6
Mailing Address - Street 2:PROMISE PROGRAM CHILDREN'S HOSPITAL OF NEW YORK
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3724
Mailing Address - Country:US
Mailing Address - Phone:646-317-1139
Mailing Address - Fax:646-317-1152
Practice Address - Street 1:635 W 165TH ST FL 6
Practice Address - Street 2:PROMISE PROGRAM CHILDREN'S HOSPITAL OF NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3724
Practice Address - Country:US
Practice Address - Phone:646-317-1139
Practice Address - Fax:646-317-1152
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019995103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical