Provider Demographics
NPI:1811726177
Name:TYAGI, ANGIE A (LSW)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:A
Last Name:TYAGI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KINDERKAMACK RD STE 201S
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1591
Mailing Address - Country:US
Mailing Address - Phone:201-266-0668
Mailing Address - Fax:
Practice Address - Street 1:800 KINDERKAMACK RD STE 201S
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1591
Practice Address - Country:US
Practice Address - Phone:201-266-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health