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 1:605 OLD FORGE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1026
Practice Address - Country:US
Practice Address - Phone:862-702-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3058082084P0800X, 2084P0804X
NJ25MA109772002084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry