Provider Demographics
NPI:1356452130
Name:FITZ, TRACY (LAC, MSTOM)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:FITZ
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531A 6TH AVE
Mailing Address - Street 2:PARLOR FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4908
Mailing Address - Country:US
Mailing Address - Phone:347-531-2320
Mailing Address - Fax:718-768-8161
Practice Address - Street 1:531A 6TH AVE
Practice Address - Street 2:PARLOR FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4908
Practice Address - Country:US
Practice Address - Phone:347-531-2320
Practice Address - Fax:718-768-8161
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001355-1171100000X
VT091-0000077171100000X
CO629171100000X
FLAP1754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163147OtherELDERPLAN
NYP2795621OtherOXFORD