Provider Demographics
NPI:1265501548
Name:ORKIN, TRACY S (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:S
Last Name:ORKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DEGRANDPRE WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6451
Mailing Address - Country:US
Mailing Address - Phone:518-561-8256
Mailing Address - Fax:
Practice Address - Street 1:16 DEGRANDPRE WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6451
Practice Address - Country:US
Practice Address - Phone:518-561-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168088-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01443076Medicaid
NY01443076Medicaid
NYRA5159Medicare ID - Type Unspecified