Provider Demographics
NPI:1114441144
Name:TREACY, CAITLIN M
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:TREACY
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 1:2600 NETHERLAND AVE APT 2123
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4825
Mailing Address - Country:US
Mailing Address - Phone:914-715-4505
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE APT 2123
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4825
Practice Address - Country:US
Practice Address - Phone:914-715-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637106-1163W00000X
NY431166363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse