Provider Demographics
NPI:1013190420
Name:NEIL TRACHTENBERG, M.D.,P.C.
Entity Type:Organization
Organization Name:NEIL TRACHTENBERG, M.D.,P.C.
Other - Org Name:222 OB/GYN P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACHTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-248-8962
Mailing Address - Street 1:300 W CLARENDON AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3449
Mailing Address - Country:US
Mailing Address - Phone:602-248-8962
Mailing Address - Fax:
Practice Address - Street 1:300 W CLARENDON AVE STE 145
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3449
Practice Address - Country:US
Practice Address - Phone:602-248-8962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCLDXMedicare PIN