Provider Demographics
NPI:1174012082
Name:TREACY, MEGAN SAMANTHA
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SAMANTHA
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 1:331 ECHO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-3520
Mailing Address - Country:US
Mailing Address - Phone:973-885-3932
Mailing Address - Fax:
Practice Address - Street 1:331 ECHO LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958-3520
Practice Address - Country:US
Practice Address - Phone:973-885-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319362164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse