Provider Demographics
NPI:1073730743
Name:TRACZIK, MONICA (RN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:TRACZIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:BLDG 1 RM 146
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-4314
Mailing Address - Fax:718-918-7686
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:BLDG 1 RM 146
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-4314
Practice Address - Fax:718-918-7686
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22583518163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice